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- MEDICAL RELEASE FORM Participant s Name Date of Birth Address Parent/Legal Guardian EMERGENCY CONTACTS Mother Daytime phone Evening phone Cell phone Father Other Relationship to Participant MEDICAL INFORMATION I give permission to and the chaperones to administer the following to my child as needed Aspirin Advil Tylenol Pepto Bismol Kaopectate Other Medicine s in student s possession My child is allergic to the following foods or medication Lis....
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