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Name of
contact person in case of emergency: Daytime Phone Number Evening Phone Number |
Personal Physician Name and Phone
Number:
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Medical
History (including significant diseases, allergies, current medications,
surgeries, etc.) (if
additional space is required, please include separate sheet) PLEASE NOTE: If you are competing in
the following sports, you must submit a medical release, signed by a licensed
physician, based on a physical completed within six months of
competition. This release should be
in the form of a doctor’s note stating fitness to compete in a contact sport. JUDO KARATE TAE KWON DO WRESTLING SUBMISSION GRAPPLING |