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Name
Signature
Date

Wakatipu High School

  
 
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ADD/ADHD Asthma Back/Neck problems Glandular Fever Migraines Diabetes Hepatitis A, B or C Depression/Anxiety Heart Condition Mobility Issues Tuberculosis Food Allergies Eating Difficulties Epilepsy Bee/Wasp Sting Allergy Metal Implants Any Mental Illness HIV or AIDS
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