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D s Full Name (please print clearly) For Ages 9110 and up, please check one of the two divisions: LJ13l14 YR OLD Gold Silver (AdvancedlCompetitive) (Beginnerllntermediate) Home# Mother IGuardian Name Cell # Mothers Email Address: Work # Father IGuardian Name Home# Fathers Email Address: Cell # Work # Emergency Contact Name Phone Number Participant Medical History Child has following conditions: Current medications, special diet, allergies: Other Information: Child s Limit.

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