WPC  'q@^g;2^gYs-ǟSrvHU*h6'*mXϔ83<ŧCUueM4VcVbB UӾG^}v7fே;?[M%[B_h5 ɽD# U X %= 0:C C U\} } } ^ w 4   m       N% f' a) f= a? fS aU fi ak f a E B C hp officejet 4100 seriesT(,,,,T(0+r2'AZ@Microsoft Sans Serif Regular($USUS.,+j AZDFranklin Gothic Medium Regular۽12 )2:i+003|xUTABLE ATABLE BxTABLE C TABLE DTABLE E ddd !USUS.,  _`^TRX3'Avery 6460 Removable 30 pX3' Letter3'Avery 8160 Ink Jet Addres3' Letter3'LetterT #i`^=#i##<5 # <57# #i#ihԀ_#M5h##iM5#i` CONCORD_ԀFENCINGCLUB  ЀMEDICALHISTORYQUESTIONNAIRE  L #`#XPXԀ( Must accompanyMembershipApplication) 8 *Uddd Xdd Xdd X(#(#,<dd ,<dd +  $ 0 0 $1.Isthereaphysicalconditionwhichmight <  preventyoufromfullyparticipatinginthe 8  physicalactivitiesofthisclass? 4   (x   D   *Udd<dd <<dd <U(#(#,<dd ,<dd +  PP 2.Doyouhaveaphysicalconditionwhich  needstobebroughttotheattentionofthe  instructor(i.e.asthma,diabetes,seizure  disorder,allergies,etc.)?       *Udd<dd <<dd <U(#(#,<dd ,<dd +   3.Areyoucurrentlyunderadoctorscare? $t    p  (x *Udd<dd <<dd <U(#(#,<dd ,<dd +  H H  4.Areyoutakingmedicationsof any kind ! (prescription,overthecounter, " naturopathic, asneeded,etc.)? #  Pleaselist.Usethebackofthisformif % " morespaceisneeded. &!#   (#%   & *Udd<dd <<dd <U(#(#,xdd +  0+'(+' dd0Name:Date:2(&,d') dd 2#XXPG#ڐ ̀CFC_MED_QUEST_08_2002REV.08_2004 #ڐ #h -L)* #M5he##iM5#i` 򀀀CONCORDFENCINGCLUB  ЀSAFETYPLEDGEANDASSUMPTIONOFRISK  L #`!#XPXԀ( Must accompanyMembershipApplication) 8 AU ) xdE xA  0 ________________________________________isenrolledinafencingclassat Concord  ? FencingClub .Allstudentsassumetherisksinherentinthesportoffencing.Asindividuals,  ; theycandomuchtolimitthisriskbythewaytheyconductthemselvesduringclass,  7  practiceandcompetition. 3  ̀ All studentsagreetothefollowingterms: +  ̀1.Iunderstandtherisksinvolvedinparticipatinginthisactivity. # ̀2.Iwillparticipatefullyinconditioningdrillstoprepareforthestressesofthesport.  ̀3.Iwillweartherequired,properlyfitted,protectiveequipment,andagreetonotify  Ѐtheinstructorifitisnotingoodrepair.  ̀4.Iagreetoobeyrulesandtospecificallyrefrainfromactionswhichmaycause  Ѐinjurytomyselforothers.  ̀5.IagreetoequipmyselfandpracticewithweaponsonlyafterIhavebeen  Ѐinstructedintheirproperuse.  ̀6.Iwillreportanyaccidentorinjurytothecourseinstructor,coachingstaff,or  Ѐcompetitionofficialsimmediately.   ̀7.Iwilltakeactiontocallanunsafesituationtotheattentionoftheinstructor, " Ѐcoachingstaff,orcompetitionofficialsimmediately. # ̀___________________________________________________________________ '"# ЀStudentSignatureDate {(#$ ̀_____________________________________________ s*%& ЀParentSignature o+&' #XXP# 򀀀CFC_SFTY_PLDGE_08_2002 󀀀 REV.08_2004  g-() #i##ii#