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CLOVIS UNITED MEDICAL RELEASE FORM 2021 Contact Information (please print) Students Name:___Age:___Grade:___DOB:___ Parents Name:___Phone:___Cell:___ Address:___Zip:___ Communication Email:___ INSURANCE:
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How to fill out clovis united medical release

01
Obtain a copy of the Clovis United Medical Release form from the appropriate source.
02
Fill in personal information such as name, date of birth, address, and emergency contact information.
03
Provide information about any medical conditions or allergies that the medical staff should be aware of.
04
Sign and date the form to indicate your consent for medical treatment in case of emergency.

Who needs clovis united medical release?

01
Anyone participating in activities organized by Clovis United that may involve physical activity or potential risks of injury.
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Clovis United Medical Release is a form that allows the release of medical information for a patient.
Patients or their legal guardians are required to file Clovis United Medical Release.
To fill out Clovis United Medical Release, one must provide their personal information, medical history, and sign the authorization for the release of medical records.
The purpose of Clovis United Medical Release is to authorize the release of medical information to specified individuals or entities.
Clovis United Medical Release must include the patient's personal information, medical history, and authorization for the release of medical records.
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