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Portland Contact Improv Regional Jam
Jam Info
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Intention
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Musicians
Preliminary Schedule
Details
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Jam Guidelines
Assumption of Liability
Medical History
Contact Info
Portland Contact Improv Regional Jam Pertinent Medical Information
Please fill out this form if you have any medical conditions that we should know about.
This information will be kept confidential, will be shared only on a “need to know” basis.
Medical History
Name
*
First
Last
Please state any medical conditions that you have which would be important for someone to know about if you should become unable to communicate or unconscious. (E.g. seizures, diabetes, severe allergies, fainting spells, etc.)
*
What do people need to know to help you? (E.g. If I am stung by a bee, please administer one dose from my Epipen in my green backpack):
*
Is there anyone specific here at the event who knows about your condition and could assist you in a medical emergency?
*
Submit