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"Best Little Paddle Shack In South Jersey"
5012 Ocean Heights Ave, Egg Harbor Twp NJ 08234
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Participant's Personal Information (Minor)
The following is requested in case of emergency

This information will only shared with medical personnel if/when needed.

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Remember...if you are unconscious; your life may depend on your answers!

 

 

Participants Name

(please print clearly) _____________________________________________________________Age:______

 

Person to contact in case of emergency: ___________________________________________________

  

Relationship: ___________________________  Phone: ________________________________________

 

Vehicle; Make/Model: _________________________ Plate #: _______________________ State: _____

 

Your Blood Type: _________  Medical Allergies: ______________________________________________

 

Are you taking any medication? ____ Detail:__________________________________________________

 

Is there medication that you need with you? ____ Detail: _______________________________________

 

_______________________________________________________________________________________

 

 Is this medication with you? ____ Where do you keep it? ________________________________________

 

 Are you wearing contact lenses?   No / Yes   Dentures or Dental Bridges?       No / Yes 

 

 Medical/Physical Conditions that we should be aware of :________________________________________

  

________________________________________________________________________________________

  

_______________________________________________________________________________________

  

________________________________________________________________________________________

  

Special Conditions / Instructions (pets/baby sitters) that we should be aware of: ______________________

  

_________________________________________________________________________________________

  

_________________________________________________________________________________________

  

_________________________________________________________________________________________

  

Participant's Signature__________________________________________________Date: ____/____/_____   

I have reviewed the above information and confirm the accuracy, and consent to my child's participation:
 

Parent / Guardian's Signature: _____________________________________________Date: ___/___/_____

 

Parent / Guardian's Printed Full Name _______________________________________________________

Additional Comments:

 
 

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Link to:
Minor Waiver & Consent Form

 
     

   

 


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Fall Store Hours:
Saturday & Sunday 10am - 6pm
Please call to confirm; we might take time off to paddle
Weekdays by appointment
Phone & Internet: Daily 7am - 10 pm

We will be Closed all day:
Sunday Sept 24
Saturday Nov 11
We will open late (after 1:30PM) on:
Saturday Sept 23
Saturday Oct 2
Sunday Oct 22
Sunday Nov 12
Sunday Dec 3
Please call 609-412-7611 to confirm late opening time

Phone & Internet: Daily 7am - 10 pm
Need us at a different date or time?

We will gladly meet you at any time that is best for you!

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Need More Information?
Contact us by email: click here
or
Speak directly to a knowledgeable staff member at
609-
653-4386

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