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KIDZ-LP / Tiffin University / Ohio


INSURANCE WAIVER (Detach and Return) Camper’s Name: _____________________________ Address: ___________________________________ City: ________________ State: ____ Zip: ________ Home Phone: ______________________________
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Document Date: 2014-04-21 12:07:25

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File Size: 482,19 KB

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Company

Ball / /

Currency

USD / /

/

Facility

Tiffin University / Basketball Kidz Camp / Kidz Camp / Gillmor Student Center / /

MedicalCondition

illness / injuries / /

Organization

Tiffin University / Gillmor Student Center / /

Person

Oswald Tiffin / Kylene Spiegel / Pam Oswald / Oswald Tiffin Women / /

/

Position

Coach / *Contact Coach / assistant coach / /

ProvinceOrState

Ohio / /

SportsGame

Basketball / /

SocialTag