ACC - Edmonton Section Summer Camp 2009: Personal Information

Some personal information is required for emergencies, and medical.  
Names, phone numbers and addresses for emergencies and for a trip participant list to be sent to all (only the name and address, e-mail, phone number list will be distributed).

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Name:
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ACC Member#:

Home phone#:
Work phone#: 

Address:





Postal Code:

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Emergency Contact Person(s)
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Name:

Relationship: 

Home phone#:
Work phone#: 

Address:





Postal Code:

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Medical Information (this remains confidential) 
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Allergies: 

Medications Taken: 

Allergies to medications:

Chronic injuries:

Chronic conditions:

Any High Altitude problems:

Age:                Weight:               Height:


Any other information: