2007 Lady Osprey ASA Softball Information Card

 First Name _______________________  Middle Initial ____  Last Name _________________________

 Address __________________________________________  City _______________  Zip ___________

 Date of Birth _________________________                                     U10/ U12 / U14 / U16/U18 (circle one)

 Insurance Provider ________________________________  Policy Number _______________________

 Parent(s):

 Emergency Contacts:

 Is your daughter allergic to any drugs? _____ If so, what? ______________________________________

 Does your daughter have any other allergies? ____  If so, what? _________________________________

 Does your daughter suffer from ____ asthma, ____ diabetes, or ____ epilepsy?

 Is your daughter taking any medications? ____ If so, what? ____________________________________

 Does your daughter wear contacts? ____

 Any Special Conditions? ________________________________________________________________

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