Medical Form
Email address *
STUDENT First Name, Last Name *
Your answer
STUDENT Email (preferably LeeSchools) *
Your answer
STUDENT Cell Phone *
Your answer
PARENT First Name, Last Name *
Your answer
PARENT Email *
Your answer
PARENT Phone *
Your answer
Home Address *
Your answer
Indicate any medication that your child is currently taking: *
Your answer
Are there any dietary concerns of which the NFMHS Band staff should be aware of? *
Your answer
List your medical insurance company and policy, ID, and/or group number. *
Your answer
Indicate the name and telephone number of your child's physician. *
Your answer
Please list any other medical data that chaperones or band staff should be aware of (allergies included). *
Your answer
If needed, do you give the staff or another parent to give your child Ibprofen/Advil? *
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