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Registration form 4 – Non-life-threatening Medical information

Other Medical information

Please indicate any of the following which apply

Allergies (non life-threatening)
Arthritis
Cardiac Conditions
Chokes Easily
Circulatory Problems
Dentures
Diabetic
Epilepsy
Fear (water, animals, etc.)
Hearing Loss
Hepatitis B Carrier
IBS
Psychiatric Illness
Respiratory Problems
Seizures
Special Diet
Stomach Problems
Wears Glasses or Contacts
Wears Braces/Special Shoes
Uses Alternative Communication

Participant Diagnosis

Events for Life Centre Inc. All rights reserved.

Charitable Registration Number: 796536290 RR0001

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