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University of Wisconsin Fond du Lac 2015 Youth Event Health Form Youth Name Birth date / Age on 1st day of event Custodial Parent/Guardian or spouse Phone Numbers Home Mary Kelly Youth Gymnastics Dates Sat. I give permission for my child to receive Tylenol or Pepto Bismol if needed. limited amount of medication for life-threatening conditions may be carried by my son/daughter/ward i.e. bee sting kit inhaler syringe. Oct. 3 10 17 24 31 2015 Event Name Sex Male Female E-mail address - Work Cell...
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