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Get Heber Valley Camp Church Activity Permission and Authorization Form

Telephone (& area code): State or province: In the event of an emergency, please contact the following individuals in this order: Name: Relation: Name: Relation: Home telephone & area code: Other telephone & area code: Home telephone & area code: Other telephone & area code: Medical Information Name of primary physician: Telephone & area code: Please explain any medical or health conditions that could affect participation in the activity such as special diet, allergies, medications, sur.

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