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NCAA ACTIVITIES AND/OR PRACTICES, ETC. THE NCAA REQUIRED CLEARANCE MUST BE SIGNED BY A HEALTHCARE PROVIDER. (LAST PAGE) WE STRONGLY URGE YOU TO MAKE A COPY FOR YOUR RECORDS!!!! CITIZENSHIP: □ US DATE OF ENTRANCE: SUMMER SPRING FALL 20 CLASS STATUS: FR__SO JR SR__GRAD__TRANSFER LAST NAME FIRST NAME MI □ OTHER D.O.B HOME ADDRESS (STREET AND NUMBER) CITY PHONE: ( ) CELL: ( ) EMERGENCY CONTACT: PHONE: ( ) RELATIONSHIP CELL: ( ) STATE/COUNTRY ZIP SPORT: □ MEN □...
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