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JULY 1st: ADDRESS: TOWN: CITY/TOWN: ZIP: MOTHER S NAME: Primary Phone: MOTHER S EMAIL: Mother Phone: FATHER S NAME: Father Phone: FATHER S EMAIL: Other Phone: PERSON TO CONTACT IN CASE OF EMERGENCY NAME: RELATIONSHIP: PHONE:(H) (W) (CELL) I authorize the LEAGUE FIRST AIDERS/COACH or EMT to act for me according to their best judgment in an emergency requiring m.

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