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Medical Liability Release Form For LiveWire Ministry Grades 5 8 events at Kingsville Community Church from September 1st 2016 August 31st 2017. Please return after completing the information on BOTH sides of this page. Student Information Name Age Birth date // Please enter as YYYY/MM/DD Grade fall 2015 School Address City/Province Postal Code Student s Cell Phone Number Student Health History Information - Circle all that apply Allergies Insect Stings Medications Medical Conditions Heart...

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