Dietary and Medical Information
To further ensure the health and safety of every CLI student, it is important that we collect the following information, which will remain completely confidential and only accessible by CLI's administrative team and personnel directly associated with your upcoming program. Completing the below form is optional.
First and Last Name *
Dietary restrictions (if applicable)
Enter as much text as needed
Medical allergies (if applicable)
Enter as much text as needed
Medical conditions (if applicable)
Enter as much text as needed
Please tick the box/boxes that apply to you. In the past 3 years, have you experienced:
If you have selected any of the above, please provide as much additional information as possible:
Electronic Signature of Applicant *
Required
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