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Camping Health, Consent and Release Form Young Life Sharedresources Younglife 2013
Licensure review. DTaP Diphtheria Tetanus Pertussis Date TD Tetanus and Diphtheria MMR Measles Mumps Rubella Polio OPV or IPV Hepatitis B Varicella Chicken Pox HIB Haemophilus influenza B Other Orthodontist Check if applicant has Asthma Bleeding/Clotting Disorder Convulsions in last 60 days Diabetes Epilepsy Frequent Ear Infections Heart Defect/Disease Hypertension Sickle Cell HEALTH HISTORY Has applicant had include date Currently Pregnant Delivered baby in last 12 weeks Chicken...
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