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HEALTH EXAM×RECORD FOR CAMPERS AND STAFF Physical must be signed by a PA, APRN or physician within the last 24 months FAX TO: RAY REID SOCCER SCHOOL 860.674.1704
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The document must be signed by an authorized individual.
Any individual or entity required to provide authorization for the document.
The authorized individual must physically sign the document using their full legal name.
The signature indicates that the individual has reviewed and approved the document.
The signature must include the date it was signed and the individual's title or position.
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