邢唷> ^`]欹g 餜>2bjbjVV8Vr<r<$, , 8D"*e*g*g*g*g*g*g*$,/`*-*4*BBB2e*Be*BBr&T]'`瓔晁DX'*Q**0*+'2//]']'/q'B**0*/, , X: 2011 3朓QAm% eP穅h NAME (First/Middle/Last) : _________________________覻 T-N噀 : ________________________ DATE OF BIRTH (Y/M/D) : 鶴u錯g t^/g/錯 ___________________________________________ AGEt^劅 :______ SEX'`+R : ____ Weight (Kg)SO蛻 ______Height (m) (珟貧)__________ PERSONAL HEALTH HISTORY Please " appropriate box, to the best of your knowledge. The purpose of this health form is to give the organizers of this camp the status of your physical health. There are certain activities in this camp that may require physical stamina that would not be suitable for your condition. Informing the organizers of your limitations would be helpful in order to avoid unforeseeable events 菑籗eP穅皨U_ 鲖9hnc╜宑醕剉酧o` =\蠎鎷瀃0WkX橯dkh0dkhh~^CJOJPJQJ^JaJnHo(tH/h>h~^CJOJPJQJ^JaJnHo(tHh_LhD8gCJOJ^JaJ h_Lh唟CJOJQJ^JaJh_Lh8CJOJ^JaJ h_LhCJOJQJ^JaJ h_Lh[ CJOJQJ^JaJ h_LhD8gCJOJQJ^JaJ h_LhCy}CJOJQJ^JaJ , < H B D R &(*46>BDf磔途療峿n^NhOJPJQJ^JnHo(tHh_LhD8gCJOJQJ^Jh_Lh CJOJQJ^Jo(+h>hB#CJOJPJQJ^JnHo(tHh_LhCy}CJOJQJ^Jo(h_LhCJOJQJ^Jo(h_Lh薭kCJOJQJ^Jo(h_LhCJOJQJ^Jh_Lh薭kCJOJQJ^Jo(h_Lh鉲gCJOJQJ^Jh_Lh鉲gCJOJQJ^Jo(h_Lh鉲gCJOJQJ^JV.X.. 00000_]XXXXXgd0kd $$IfT杔謀\ $T064 layt奣0001 111T1V1j1l1n1祥虎塺Y?*(h_Lh CJOJQJ^JaJmH sH 3h_Lh薱CJOJQJ^JaJmH nHo(sH tH0h薱5丆JOJQJ^JaJmH nHo(sH tH-h CJOJQJ^JaJmH nHo(sH tH0h_LhCJOJQJ^JaJmH nHsH tH0h_Lh CJOJQJ^JaJmH nHsH tH&h_Lh 5丱JQJ^JnHo(tH3h_Lh 5丆JOJQJ^JaJmH nHsH tHh_Lh 5丱JQJ^Jo( h_Lh 0V1l1n11111222 2 282:2<2>2$a$gd鮴gd $劆^劆a$gd協F$a$gd$8刪[$\$^8`刪a$gdn1v1z1|1111112222 2222 2"2,282:2<2>2橛沪巻倖倖倖倉xsnsine値h_M, h.I>o( h鮴o( h朹o( hFQo( h薱o(hXjhXU.h協Fh5丆JOJQJ^JaJmH o(sH (h鷊h CJOJQJ^JaJmH sH .h_Lh 5丆JOJQJ^JaJmH o(sH +h_Lh 5丆JOJQJ^JaJmH sH +h_LhV>5丆JOJQJ^JaJmH sH 6&P 1恏:p蛅皞. 捌A!半"#惐$惐%癝隘 惸$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣$$If!vh#v#v#v#vG:V 杔06555T4yt奣b 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~PJ_HmH nHsH tH<`< ck噀CJ_HaJmH nHsH tH^@^ nh槝 1)$$$ & FdB1$@&a$5丆J,KH,\乤J,j@j nh槝 2)$$$ & Fd1$@&a$5丆J KHOJPJQJ\乤J ^@^ nh槝 3)$$$ & Fd1$@&a$5丆J KH\乤J j@j nh槝 4)$$$ & Fdx"1$@&a$5丆JKHOJPJQJ\乤J^@^ nh槝 5)$$$ & Fdx"1$@&a$5丆JKH\乤Jb@b nh槝 6)$$$ & Fd@ゐ1$@&a$5並HOJPJQJ\乂@V nh槝 7)$$$ & Fd@ゐ1$@&a$ 5並H\乗@\ nh槝 8)$$$ & Fd@ゐ1$@&a$KHOJPJQJd @d nh槝 9) $$$ & Fd@ゐ1$@&a$CJKHOJPJQJaJ$A $ 貫祂=刉[SOFi@F nf恏@, h槝$a$5乗<@< I`u w$ 9r G$a$CJaJ6 @6 eu 9r G$CJaJ*U`!* 5厤 >*B* ph)1  5ux\C\  5QU"*$CJPJaJtH.橜. 'Byb鑜Fh噀,gCJaJPK!檗[Content_Types].xml瑧薔0E鱄鼉-J湶@%閭菐洽|廊$韶钵UL襎B l,3鳛;鉹得槣B+$G]ミ7O侪V墎xjm)尸uWLfd湑莓+5_惪4csＵj-V?k3鴷蕆m}蚜惻譯鸬謟唤爨 肉梘疠s嶅殝7爯褁w陧σs葓惩R 繵*)|妭j全K馲瞳咪 dX㊣BF貒bn鉮 ( *羺'v蓷3KZ捑爥jz'c*镎语_=}<9阁恿莼w~磦淽8娀^~_o?鍃Y媒g縹^匂櫄簏薌}J灢0礊E鞝m祁h钤=踉剳艘 螢a>s$-, 酧萆犂=Hp Ua/ 鞺O d*:(.媐筎镀绵U钞/!9$V[|h棗魊v兹s⊥-i荱秚. 窘幉6曦讵4C妿盾ebs)噽绠羈Mj孊錯跟k誴倭 u躮幉礃,渇奷垏$蛻鰗6GU摛琕f褈豣#兄衎這踧扵TW洠.宿沝)i朄卺vdq9Y岞沕＞X鲪彄7倇2%恥╃Hx玟+a塔萬6]>蚮#s蘭*贱皅焣蒯丏H祦ehK稒)棁虭撆?71Ηo秅go齚:f詹e叄爲洱k歱拢2謱菋跆8肉皹D 糃B?81e>nE疱eU}H类dm1iQ6撮瑜支<殒z[[v渱0伫p妾sz4儩F貕礭j褥叆Qv11邧可鈨洂 `虜4逽 3t萧4空h懂 PK! 褠煻'theme/theme/_rels/themeManager.xml.rels剰M 0匃倃oo雍&輬协勪5 6?$Q祉 ,.嘺緳i粭澤c21h:闀q毩m胳嶡RN壻;d癭値o7g慘(M&$R(.1榬'J摐袏T鶂8V"＆A然蠬鱱}狇|$絙{朠除8塯/]As賲(⑵锑#洩L蔥汉倪PK-!檗[Content_Types].xmlPK-!ブх6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!閘N嵈theme/theme/theme1.xmlPK-! 褠煻' theme/theme/_rels/themeManager.xml.relsPK]  V #####&| f .0n1>2 &(*Bp 2d8,j,,,,-6-^-~---.V.0>2  !"#$%')餈 @餒 0(  饞0(  養 S  ?DJ~ 35GJ_b02FHY[np %(    3,h  ,,,d 贛 #  篟Vt^`^`^`^`^`^`^`^`^`剺^`剺. ^`噃圚,{ ag ^`噃圚倐 . 勑凱^勑`凱h圚() 刞刾`^刞`刾噃圚() 勷凱^勷`凱h圚) 剙凱^剙`凱h圚) 勦^`勦h圚) 劆凱^劆`凱h圚. 0刾0^0`刾噃圚. 剟剺^剟`剺JQJo(. 凾剺T^凾`剺h圚. $凩$^$`凩噃圚. 勽 剺 ^勽 `剺h圚. 勀 剺 ^勀 `剺h圚. 剶凩^剶`凩噃圚. 刣剺d^刣`剺h圚. 4剺4^4`剺h圚. 凩^`凩噃圚.贛 篟OutlineWW8Num3~V釫          R> 'D  3 ?8cu絤舗t"B#u$"'+'E+_M,q2v03EF4欳5巎5抐7(8藽9E=^E=.I>@'BXvCDkEF協FKGHhHKmIM~ N RX#[(`^塂_Z6`Wb>c?de鉳fD8g鉲ghiOvi薭k鵯k#zk峉mnn﹡s]~y +z蜙}衁}Cy}+h/J[V>W`蛅絳>豼'_鶴_L)#*Q朹,^橲I%FQ|I`>橻攍薱E[芓!9!5竮砮c>US|}A&鵈6??{N~^P-鷊鮴0鳸穤IEwY+5騋峉nh* Y[讀鬹K`h刔zHN7乴!/E_闡 5唟琾-rlr葂J 2>[ r`f"++@  (XX X,UnknownG*郃x Times New Roman5Symbol3. *郈x Arial5. .醄`)TahomaC 狕(PMingLiU癳0}f詺;(媅SOSimSun;= 鷟8褳SOSimHeiA$BCambria Math"鹦h祵髥L捏B礔   !亖24 3僎HX?t"2!xx  HEALTH FORM pediatricsViolet   鄥燆鵒h珣+'迟0x  ( 4 @ LX`hp HEALTH FORM pediatrics Normal.dotmViolet8Microsoft Office Word@@p=懬@嶪{戜@0#晁 胀諟.摋+,0 X`px Vista    !"#$%&'()*+-./012356789:;<=>?@ABCDEFGHIJKLNOPQRSTVWXYZ[\_Root Entry Fp晁aData ,1Table40WordDocument8VSummaryInformation(MDocumentSummaryInformation8UCompObjn  FMicrosoft Word 97-2003 文档 MSWordDocWord.Document.89瞦