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I consent to the disclosure to the MHSAA of information otherwise protected by FERPA and HIPPA for the purpose of determining eligibility for interscholastic athletics. THIS FORM MUST BE ON FILE IN THE HIGH SCHOOL OFFICE BEFORE PRACTICING WITH ANY ATHLETIC TEAM PURSUANT TO MHSAA RULES PHYSICAL EXAMINATION To be completed by athlete/parent prior to physical HISTORY Have you ever had Fainting Diphtheria Scarlet Fever Rheumatism Rupture Rheumatic Fever YES NO Kidney Disease Tuberculosis Jaundice...
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