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No If No Please Indicate DTaP Diphtheria Tetanus Pertussis MMR Measles Mumps Rubella Polio Chickenpox Other Can applicant swim Yes If yes can applicant participate in water activities Yes No Can applicant participate in sport activities Yes If No Please Explain. Release and Consent Form Consent to Issue Medication I the parent/guardian of the applicant hereby authorize the staff of the Prince Hall Masonic Youth Camp and or members of the Most Worshipful Prince Hall Grand Lodge of Texas to...

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