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CCMR Emergency Contact Information
Please fill out and submit this form. This information may be accessible to fellow rowers; please add any confidential health information* to the copy you will carry while rowing.
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1
Your Name
First Name
Last Name
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2
Your Email
example@example.com
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3
Your Phone Number
CELL PHONE
Area Code
Phone Number
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4
Name of Emergency Contact #1/ Relationship to you/Phone Number
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5
Name of Emergency Contact #2/Relationship to you/Phone Number
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6
*Allergies/Medical Conditions/Medications and any other information you would need to share in a medical emergency
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