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Cdc.gov/Concussion. U.S. D EPARTMENT OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION June 2010 I the undersigned am the parent/legal guardian of a minor and Student-Athlete. A concussion can aff ect reaction time balance sleep classroom performance and the ability to perform every day activities. Please complete this form and fax it to 603-627-0880 GRANITE STATE GAMES ATHLETE MEDICAL INFORMATION Student Athlete Name Date of Birth Allergies Current Medications i.e....
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