Please complete this form with as much detail as possible. If Adeline has any concerns or questions, she will contact you to discuss this.
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  • Any cardiac (heart) or respiratory (breathing difficulties now or in the past.
    Any Kidney or liver problems
    Incontinence (bladder or bowel)
    Contagious diseases
    Skin sensitivity to chlorine or contagious skin conditions
    Uncontrolled vertigo or epilepsy
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