STUDENT MEDICAL INFORMATION

THIS FORM MUST BE COMPLETED IN FULL BEORE PARTICIPATING IN ANY PROGRAMS, CLASSES OR CAMPS.
All information is kept confidential and will only be disclosed in the event of a medical emergency or if first aid treatment is required.


PARTICIPANT INFORMATION

EMERGENCY CONTACT INFORMATION

PARTICIPANT MEDICAL INFORMATION

Please complete all responses. Provide extra information at the bottom of the form.
Please list any medications the participant is currently taking including over-the-counter and prescription.
Please include any information not covered above.

DECLARATION