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department of athletics policies & procedures - UNC Wilmington ...

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Vision History<br />

Explain<br />

Do you wear glasses during sports participation? Y N<br />

Do you wear contacts during sports participation? Y N<br />

Do you have any type <strong>of</strong> eye trouble? Y N<br />

Dental History<br />

Do you have any chipped, loose, or missing teeth? Y N (which ones?)<br />

Do you wear a dental appliance? Y N (what type?)<br />

Family History<br />

Have any <strong>of</strong> the following conditions been present in your immediate family?<br />

Congenital (born with) heart disease Y N<br />

Marfan’s syndrome Y N<br />

Sickle cell anemia or trait Y N<br />

Death while exercising Y N<br />

Died aged

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