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Get MiLB Winston-Salem Dash Youth Baseball Academy Medical Form

Y. Participation will not be permitted until this form has been completed and signed and is on file with the training academy. PLEASE PRINT USING BLACK OR BLUE INK PARTICIPANT INFORMATION: NAME: AGE: FIRST MIDDLE DATE OF BIRTH: / / LAST HOME ADDRESS: Street Address City State FATHER/GUARDIAN NAME: ADDRESS: PHONE: Home ( ) Work ( ) Cell ( ) MOTHER/GUARDIAN NAME: ADDRESS: PHONE: Home ( ) Work ( ) Cell ( ) Work ( ) Cell ( ) OTHER/EMERGENCY CONTACT: ADDRESS: PHONE: Hom.

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