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THE 2017 UNIVERSITY OF MARYLAND BASKETBALL 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 YES NO Epilepsy Diabetes Known Allergies Rheumatic Fever or Heart Murmur Head Injury with Unconsciousness Operations Irregular Heart Beat or High Blood Pressure Dizziness Palpitations Recent...
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