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PO Box 1325 Brevard, NC 28712 8288833375Riders Medical History and Physicians Statement To be completed by Licensed PHYSICIAN Name: Date of Birth: Parent/Guardian: Phone: Cell: Height: Weight: Diagnosis:
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How to fill out NC Free Rein Riders Medical History and
01
Begin by writing your personal information at the top of the form, including your name, date of birth, and contact information.
02
Fill out the emergency contact details, providing a name and phone number for someone who can be reached in case of an emergency.
03
Complete the medical history section by listing any current or past medical conditions, surgeries, or significant illnesses.
04
Note any allergies you have, especially to medications or environmental factors.
05
Include information about any medications you are currently taking, including dosage and frequency.
06
Answer questions regarding your vaccination history and indicate if you have received all required vaccinations.
07
Sign and date the form, confirming that all information provided is accurate and up-to-date.
Who needs NC Free Rein Riders Medical History and?
01
Individuals who wish to participate in NC Free Rein Riders programs or activities need to fill out the Medical History form.
02
Parents or guardians of minors participating in NC Free Rein Riders must complete the form on their behalf.
03
Staff and health care providers involved in the care of the participants may need this information for safety and health considerations.
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What is NC Free Rein Riders Medical History?
NC Free Rein Riders Medical History is a document that collects important health information from riders to ensure their safety and well-being during riding activities.
Who is required to file NC Free Rein Riders Medical History?
All participants of the NC Free Rein Riders program are required to file a medical history form before participating in any riding activities.
How to fill out NC Free Rein Riders Medical History?
To fill out the NC Free Rein Riders Medical History, participants need to provide accurate and detailed information about their medical conditions, medications, allergies, and emergency contact details.
What is the purpose of NC Free Rein Riders Medical History?
The purpose of the NC Free Rein Riders Medical History is to ensure that the riding program can appropriately address the health needs of participants and respond effectively in case of a medical emergency.
What information must be reported on NC Free Rein Riders Medical History?
Participants must report any existing medical conditions, allergies, medications they are taking, and provide emergency contact information on the NC Free Rein Riders Medical History.
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