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Get UGA Health Form For Summer Camps And Programs 2020

Ty Health Center if the participant should become ill or injured while on campus. FAX to 706-542-4959 prior to camp/program. Please note, there will be charges for services provided by the University Health Center. NAME DATE OF BIRTH HOME STREET ADDRESS CITY, STATE, ZIP CODE GENDER PROGRAM PHONE ( ) PROGRAM CONTACT PERSON PHONE ( ) PERMISSION FOR DIAGNOSTIC AND TREATMENT PROCEDURES I hereby authorize the.

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