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Ever been knocked unconscious asthma 6. Wear glasses contacts or protective eyewear 15a. If yes how severe 15b. AUTHORIZATION TO RELEASE TO ANOTHER AFTERSCHOOL PROGRAM Will your dependent go to another afterschool program after the Girls on the Run lesson Program Name GOTR HISTORY Has your daughter participated in Girls on the Run during a prior season FORMCHECKBOX Yes GENERAL HEALTH QUESTIONS If Yes please explain below QUESTION YES NO 1. Place s of Employment Race/Ethnicity Disclosure...

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