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Or all 4-H Youth Development meetings and activities during the dates specified below: (Please Note: This information must be updated annually) First Name Last Name Club/Unit Name to County and State Dates (From / To) While I am attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H VOLUNTEER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR ME SHOULD I BE U.

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