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Get CA Perris Union High School District Athletic Emergency/Medical Information & Participation Form

Occer Wrestling Girls Water Polo SPRING Baseball Boys Golf Softball Swimming Boys Tennis Track Boys Volleyball MULTI Cheer Team Manager Band Color Guard NJROTC OTHER: Athlete s Name: Address: Today s Date: City: State: CA Zip Code: Home Phone: Grade: Age: Gender: Date of Birth: Place of Birth: Father/Guardian s Name: Phone: Employer: Mother/Guardian s Name: Phone: Employer: Emergency Phone Number: Cell #: E-Mail: Family Physician: Phone Number: School attended previous semester: List.

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