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Evergreen 2022-2023 Emergency Contact Form
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Email
*
Your email
Name(s) of Participants. If participant is a minor, please tell us their ages.
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Your answer
If the above participant(s) are minors please tell us who the primary adult contact is. If the participant is an adult, skip to question 3.
Your answer
Email address (for paren/guardian if participant is a minor)
*
Your answer
Phone number (for parent/guardian if participant is a minor)
*
Your answer
Mailing address
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Your answer
In case of an emergency and the primary contact can not be reached, who should we contact? Please list a name and a phone number.
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Your answer
Please list any participants who have any type of allergies and tell us what these allergies are.
Your answer
Please list any participants who have any medical conditions that we should be aware of such as diabetes, or asthma.
Your answer
Is there a particular hospital you would prefer in case of an emergency?
Your answer
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