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OP WJUINBB Pop Warner Little Scholars Inc. 586 Middletown Blvd. Suite C-100 - Langhorne - PA -19047 Phone 215-752-2691 - Fax 215-752-2879 www. Signature of Parent or Legal Guardian Print Name Relationship to Patticipant Dated 1/18/2010 po WARNBR W a Section II THIS SECTION IS TO BE COMPLETED ONLY BY A MEDICAL PROFESSIONAL Name ofParticipant Please check the following ifhealthy or note otherwise Weight Mouth Ears Respiratory Cardiovascular M uskoskeletal Dermatological Eyes Nose Throat...

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