Big Buck Down Outfitters

4181 Shepler Church Ave. Sw

Canton, OH 44706

bbdohio@yahoo.com

330-844-6625

 EMERGENCY MEDICAL FORM

Name:__________________________________________________________________________

 

Address:________________________________________________________________________

 

City/ State/ Zip:___________________________________________________________________

 

Date of Last Tetanus:_______________________________________________________________

 

In case of an emergency please list 2 contacts and phone numbers:

1) ___________________________________ (_______)_______________________________

 

2)___________________________________ (_______)________________________________

 

Medical History: Facts concerning your medical history including allergies, medications being taken and any physical impairment of which a physician or your hunting guide should be alerted:

________________________________________________________________________________

 

________________________________________________________________________________