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THE 2017 DUAL SPORTS CAMP AT THE DISCOVERY SPORTS CENTER MEDICAL FORM Please print or type fill out completely Camper Information Last Name Address First Name City MI DOB State Age Zip Parent/Guardian Name Home Phone Contact Number Mom PERSON TO CONTACT IN CASE OF EMERGENCY Phone Epilepsy Diabetes Known Allergies Rheumatic Fever or Heart Murmur Head Injury with Unconsciousness Operations Irregular Heart Beat or High Blood Pressure Dizziness Palpitations Recent Injuries Neck Spine Joints etc....
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