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Indicate the data in RECOMMENDATIONS CLEARED WITHOUT, I certify that I have examined the, Signature MD DO PA or NP, Participation in interscholastic, ParentLegal Guardian Signature Date, StudentAthlete SignatureDate, Authorization of Treatment, I hereby give my permission for, ParentLegal Guardian Signature Date, A CurrentYear Physical is one, and A CurrentYear Physical is one.
It is important to give particular details in the section Medical History, Do you have any chronic or, No If yes explain, Yes, Have you ever been hospitalized, No If yes explain, Yes, Do you have any allergies, No If yes explain, Yes, Are you currently taking any, No If yes explain Have you had a, Yes, Have you ever passed out or, and Yes Yes Yes Yes Yes Yes.
The Heart murmur High cholesterol, No No No, Hypertrophic cardiomyopathy Marfan, Have you ever had a concussion, No If yes explain, Yes, Have you ever been knocked out or, No If yes explain, Yes, Do you have headaches with exercise, No If yes explain, Yes, Have you ever had any of the, Prolonged headache Confusion, and Inability to move your arms or legs area has to be used to put down the rights or obligations of both parties.
Finish by reading the following sections and filling in the proper information: Have you ever had a stinger burner, No If yes explain, Yes, Have you ever had seizures, No If yes explain, Yes, No If yes explain, I hereby state that to the best of, and Signature of Athlete Date.
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