P.O. Box 609
Bellport, NY  11713

BELLPORT BAY 
SAILING FOUNDATION

Subtitle

Bellport Bay Sailing Foundation
Medical Emergency Authorization

I hereby authorize the Bellport Bay Sailing Foundation, and its employees, agents or representatives, or any adult who bears this document, to authorize emergency treatment of the below listed participant in the event a parent or legal guardian cannot be contacted at the time of the emergency at the telephone numbers below.

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