Medical Information Form

MEDICAL INFORMATION

Your email address: *

Select the event and associated campus that you or your child will be attending: *

Participant's Full Name *

Event Registration Confirmation #
(This number is located in your confirmation email when you registered online for Beach Retreat, Next Level Camp, or 6th Grade Camp.) *

Are you completing this waiver for yourself/an adult (over 18 years of age) or for a minor (18 and under)? *

I am attending this event and completing this form for myself (Adult, Over 18)

I am completing this for my student (Minor, 18 and Under)

Would you like a printer-friendly copy of this document sent to you via an email upon completion? *

Yes

No

WHAT YOU WILL NEED:

You will need the following information readily available to complete this form.The time required to complete this form may take 10-20 minutes depending on the participant's medical history.

Registration Confirmation Number (Provided in your Confirmation Email)
Emergency Contact Info
Medical History
Allergies
Immunization Information
List of Medications
Insurance Information
Picture or Scanned Image of the front and back of your insurance card
Physician Provided Care Plans for those with Diabetes, Asthma, or Seizures

SAVE & RETURN:

For your convenience, you may use our optional 'Save & Return' feature to create a login to this form. Your progress will be saved and you may return at a later time to complete this form. To use the Save & Return feature, CLICK HERE to get started. Be sure to write down your password!

Otherwise, click 'Next' below to continue.