ACFkids Spring Retreat Medical Release 2020

ACFkids Spring Retreat Medical Release 2020

You will need your medical insurance info and the date of last tetanus shot in order to complete this form. We recommend gathering this info before you begin.

Participant's Info

First
Last
Street
City/State/Zip
Name & Phone

Medical Profile

Generally, the participant's health is

Insurance Info

Permission, Acknowledgements, Release, Indemnity

Please type your full name, which will serve as your signature on this form.
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