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The Lighthouse Christian Academy 1424 Yale Street Santa Monica, CA 90404 p 310.829.2522 f 310.829.5544 www.LCAsaints.org PHYSICAL EXAM FORM Student Name: Address: Date of Physical: Age: Date of Birth:
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The purpose is to document an individual's physical health status.
Physical check-up results, medical history, and current health conditions.
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