MEDICAL INFORATION Sample Clauses

MEDICAL INFORATION. It is recommended that you consult with a physician prior to participating in this UTRGV Summer Camp. If you are uncertain about any pre-existing medical conditions, it is your responsibility to consult with your own physician prior to participating in this Summer Camp. Please answer all of the questions. If you answer yes to any of the following questions, please explain as indicated. Use back and/or additional paper if needed. Physician’s name: Phone Number: Are you up to date with immunizations required by your school (check one) Yes No If you are participating in an overnight camp, a copy of your immunization record will be required. Do you have health/accident insurance (check one) Yes No If yes, please indicate policy number, name, and address of company. Please include a copy of the back and front of your insurance card. Company Name/Address Policy Number: For the following, circle appropriate response and explain as appropriate: Does camper have any limiting medical conditions that you or your doctor feel would limit camp participation? Yes No If yes, identify and explain: Is camper currently taking medication that may interfere with ability to safely participate in Camp? Yes No If yes, identify and explain: Does camper have a history of allergies or reactions to medications, insect stings, or plants? Yes No If yes, identify and explain: Does camper have a history of, or currently suffer from, medical conditions(s) with which we should be aware? Yes No If yes, identify and explain: