Microsoft word - corrected medical form
White Pines Ranch Outdoor Education Center 3581 Pines Rd, Oregon IL 61061 (815-732-7923) Fax (815-732-7924) Emergency Medical Information School: Fairview South School Dates at WPR: September 11 – 13, 2013 Name of Participant_____________________Age____Birthdate______Boy/Girl Address ________________________City ____________ State ___ Zip_____ Name of Parent(s): ___