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Emergency and Medical Information
Please complete ALL information accurately. If any information changes after you submit the form, please notify Mr. Martini
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Email
*
Your email
STUDENT'S FIRST NAME
*
Your answer
STUDENT'S LAST NAME
*
Your answer
STUDENT'S CELL PHONE
please follow format xxx-xxx-xxxx
Your answer
HEIGHT
*
Your answer
WEIGHT
*
Your answer
DATE OF BIRTH
*
Your answer
STUDENT CYSD USERNAME
*
e.g. 18jmartini
Your answer
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