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Do you have any conditions that may adversely affect your capacity to participate in this activity
Asthma, bronchitis, pulmonary tuberculosis or other lung diseases
Fainting spells, status epileptics, migraine, other head injuries
Any present back or spinal injuries
Any present dislocations, sprains or muscle pains
Any other disablilites or medical information to note
Fill in with No if none exists
I declare that all the above information is true to the best of my knowledge and have not withheld any vital information. I am currently not suffering from any ilnesses that may harm other or myself in course of this sport
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