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Get Medical Report And Waiver.pdf - City Of Kelowna

CTOR ON THE FIRST DAY OF CLASS For the health, safety, and comfort of the participant, it is required that this form be filled out accurately once per year or if any medical condition changes. Please answer all questions. Name: Doctor s Name: Address: Personal Medical #: Phone: Phone: Date of Birth: Fax: Person to call in case of emergency: Phone: Male Female MEDICAL HISTORY Please complete in point form Medication: if the participant is under medication please list below G.

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