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  DEKALB ALL-STAR BOWL   
       DECEMBER 19, 2009
  HALLFORD STADIUM
A Partnership of the  DeKalb County Schools Athletics Department and
American Youth Council, Inc.
Copyright 2009
www.dekalballstarbowl.com
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DeKalb All Star Bowl Player Health Information

Players will be covered under a group liability policy for the event. There will be a medical trainer on site at all times, and emergency care will be summoned if required. If a player requires further medical treatment, he will be transported to an appropriate medical facility. There are doctors and hospitals minutes away from the event facility. Every effort is made to protect the health and safety of the players. No payment for medical services is agreed to or implied by American Youth Council, Inc. , or by any host High School.

For immunizations, insert the appropriate dates or, if dates are not readily available but immunizations are up to date, type 'Current'. If no immunizations, type 'NO'. When you hit the 'submit' button you will be sent to the 'Thank You' page and your registration will be complete.

Hepatitis B:
TB Test:
Rubella:
Rubella Booster:
Chicken Pox:
Meningitis:
Tetanus:
Measles:
DTP Series
PHYSICIANS CLEARANCE: Players with the following conditions must provide written physician's clearance before attending camp. Please specify the condition in the space provided, and bring physician's letter to Kickoff Mini Camp on December 12, 2009. By leaving the space blank you state none of the conditions apply.
Fracture in the last 6 mos.
Surgery in the past year::
Spinal or Head Injury:
Diabetes:
Heart Condition:
Loss of Organ:
Hemophilia:
Seizure Disorder:
Hospitalization in the last 6 mos:
PARENT/GUARDIAN AUTHORIZATION: To the best of my knowledge the health information provided is correct and the person described herein has my permission to engage in all DeKalb All Star Bowl activities, with the exception of any physical limitation as described.
PLAYER:
PARENT/GUARDIAN:
WITNESS: