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EVENT: _______________________________________

Coach/Co-Coach/Chaperone Gallery Cert. of Affidavit Medical Cert. of Cert. of License/ Track Record
Employment Sworn Cert Training Sports Certification/ of
Statement Membership Accreditation Participation

EVEDENT NOT EVIDENT

GALLERY ____________________ ________________________

Athlete AR1 NSO/PSA SF10 Cert. Of Enrollment Parent Medical Dental


attendance and Consent Record Cert.
Completion

_____________________________________________________
Name and Signature of CSAC

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