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Medical Details and Consent Form 1 APRIL 2010 - 31 MARCH 2011
Medical Details and Consent Form 1 APRIL 2010 - 31 MARCH 2011
01827 830303
E-mail: kangagym@aol.com
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Is he allergic to anything? (e.g. aspirin, antibiotics, any particular food or drug?) If so give
details:-
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Does he suffer from any of the following: asthma, chest complaints, hay fever, migraine, fits
or faints, travel sickness, diabetes, celiac disease or any other illness or disability? If so
give details:-
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Is he having any medical treatment at present? If so, please give details of treatment and
medicines, etc.
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