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Ave any food allergies? (Please describe below.) Yes Bedwetting No Has there been any recent events in your child s life (ex: death of a family member or pet) that may be concerning your child. Please explain: Does your daughter have any restrictions while at camp? Please explain: Are there any other concerns you would like to share? Yes No MEDICAL EXAMINATION: THIS SECTION TO BE COMPLETED BY PHYSICIAN (PLEASE PRINT) This Medical Examination to be completed by a licensed physician. T.

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