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MAMBEC REGISTRATION

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Child's Last Name

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Does the Member Require a Life Jacket

Medical Information

Does the member have any medical conditions, diseases or illnesses?

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Does the member have any allergies?

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Is the Member on any Medications?

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If Yes, Please Specify Condition

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If Yes, Please Specify Medications

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Copyright MAMBEC (Martial Art Mind Body Education Centre) Inc. 2003
MAMBEC is a member of Karate Nova Scotia in affiliation with Sport Nova Scotia

info@mambec.com

(902) 488-6779

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