This government document is issued by Education, Department for use in New Jersey
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https://www.google.com/url?client=internal-element-cse&cx=f1a222ae9af1a47bb&q=https://www.nj.gov/education/safety/health/athlete/docs/athleticphysicalsform.pdf&sa=U&ved=2ahUKEwjtpuKguZSGAxXH3wIHHcfyBvU4FBAWegQIBxAB&usg=AOvVaw1QAStA6nUs8WIw8VPsGbbp&arm=e&fexp=72519171,72519168