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Health Card Form

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					                             GAME DAY - Jr. High Convention 2012
HEALTH CARD INFO: Church _____________________________________ City _________________________
To ensure quickness in dealing with any potential medical problems, please place each registrant’s health card # on the
sheet below AND send it in with the bulk form. Please note the version code (2 letters) as well as the expiry date.
                                 HEALTH CARD #, Version,                                        HEALTH CARD #, Version,
      MALE COACH NAME                                               FEMALE COACH NAME
                                        Expiry Date                                                    Expiry Date
1.                                                            1.


2.                                                            2.

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5.                                                            5.
                                 HEALTH CARD #, Version,                                        HEALTH CARD #, Version,
      MALE JR. HIGH NAME                                            FEMALE JR. HIGH NAME
                                        Expiry Date                                                    Expiry Date
1.                                                            1.

2.                                                            2.

3.                                                            3.

4.                                                            4.

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posted:10/15/2012
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