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Ram Round-Up Medical Information Form

This form is to be completed by the student attending Ram Round-Up. (A parent or legal guardian must complete and certify the form for students under the age of 18.)

All information regarding healthcare providers and medical history will be kept in strict confidence and will only be shared in case of an emergency to provide and/or seek appropriate medical treatment.

I understand that the information requested on this form is intended to help inform camp staff of any pre-existing medical, mental, or physical conditions that I may have and that I am responsible for providing an accurate history.

All fields marked with an asterisk (*) are required.

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Camp Attending:*
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Sex:*
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Please bring a copy of your insurance card to camp. If you do not have insurance please type N/A.
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If you do not have insurance please type N/A.
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Please check box below to acknowledge liability.*
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Please check box below to acknowledge liability.*
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Are you currently taking any medication?*
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Do you have a history of or any medical condition that you or your doctor feel would limit your participation?*
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Any allergies or reactions to foods, medications, insect stings, plants, or other materials?*
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Please check box below to acknowledge responsibility regarding medication.*
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Please check box below to acknowledge personal responsibility.*
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Please check box below to acknowledge terms outlined on this medical release form.*
In case of illness or medical emergency occurring during participation in an Angelo State University sponsored camp or related activity, the University and Camp Facility, their employees or agents may, but are not obligated to, take actions to secure whatever treatment it considers to be warranted under the circumstances. Every effort will be made to notify an emergency contact prior to treatment but this may not be practical. Before medical treatment can be provided, we are required to have a signed medical release to present to the medical provider at the time of treatment.
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Please check box below to acknowledge terms outlined on this medical release form.*
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Please check the appropriate box below to acknowledge/agree to statements on this medical release form.*
Check one box only.
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If under the age of 18 please have a parent or legal guardian check the box below to acknowledge/agree to statements on this medical release form.
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Consent:*