Registration Form – Relay team

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Team member 1

Emergency information

Is a history of diseases related to the heart, lungs, liver, kidneys, and bones and joints

1. If there is no medical history: please write "NO"

2. If you have a medical history: Please clearly state your medical history

Team member 2

Emergency information

Is a history of diseases related to the heart, lungs, liver, kidneys, and bones and joints

1. If there is no medical history: please write "NO"

2. If you have a medical history: Please clearly state your medical history

Team member 3

Emergency information

Is a history of diseases related to the heart, lungs, liver, kidneys, and bones and joints

1. If there is no medical history: please write "NO"

2. If you have a medical history: Please clearly state your medical history