Outdoor Lab Medical Form
All 6th grade students and high school leaders must have a medical form submitted by a parent/guardian in order to attend Outdoor Lab.
Email address *
What is the password to access this form? *
Are you filling this out for a 6th grader or a high school leader? *
STUDENT'S first name *
STUDENT'S last name *
STUDENT'S birth date *
MM
/
DD
/
YYYY
Parent/Guardian first and last name *
Parent/Guardian phone number *
Parent/Guardian email *
In the event we cannot reach the contact above, please list an emergency contact name and phone number. *
Does your student have any medical conditions/concerns or a recent injury/hospitalization? If yes, please LIST ALL below. If none, type N/A. *
Does your student have any activity restrictions or limitations? If yes, please LIST ALL below. If none, type N/A. *
The following medications are available at both Mt Evans and Windy Peak and may be administered by the Outdoor Lab clinic staff when indicated. Check each medication that you give permission for the Outdoor Lab staff to administer. *
Required
Does your student have asthma? *
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