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Get University Of Wisconsin Youth Event Health Form Event Contact ...

Y of Event Male Parent/Guardian Name (last name, first name) Address (street, city, state, zip code) Email Home Phone Work Phone Cell Phone Second Parent/Guardian Name Second Address Second Email Second Home Phone Second Work Phone Second Cell Phone Health Conditions Heart: include if physician denied or restricted sports Epilepsy Dizziness or Fainting Diabetes Muscular/Skeletal Other Asthma: Is an inhaler required and carried by the youth? participation Cognitive or Develo.

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