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Get Physical Fitness Certificate Filled Form

S information is collected to assist the Scouter in charge should a medical emergency arise. In accordance with applicable Privacy Legislation, this information will not be used for any other purpose. Surname: Given Name: Initial: Date of Birth: Age: Male Female City: Address: Province: Postal Code: Home Phone #: Physician s Name: Phone # Scout Group Name: *Provincial Medical Plan: Insurance Coverage Held: Emergency Contact Name:.

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