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OASL Summer Workshop Forms 2022
This form includes: Health Form, Assumption of Risk Form, Photo Release Form & Student Guidelines Form, and
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* Indicates required question
Email
*
Your email
Last name of student
*
Your answer
First name of student
*
Your answer
School
*
Your answer
My student registered for:
*
July 13-17, Senior High, Capital University
July 13-17, Middle Level, Capital University
July 20-24, Senior High, Capital University
Home Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Insurance Provider's Name
*
Your answer
Policy #
*
Your answer
Will the above named student be taking any medication during the workshop?
*
Yes
No
If yes, please list any medications the named student is currently taking:
Your answer
Should the above named student's activity be restricted in any way during workshop?
*
Yes
No
If yes, please explain the student's activity restrictions:
Your answer
Please list any allergies the student has:
Your answer
My student has permission to take the following over the counter medicine as needed:
*
Please check all that apply.
Acetaminophen (Tylenol)
Ibuprofen (Advil, Motrin)
Pepto-Bismol
Midol
None of the above
Required
Health Form Parent/Guardian Electronic Signature:
*
Your answer
Parent/Guardian Emergency Phone Number:
*
Your answer
Additional Parent/Guardian Emergency Phone Number:
*
Your answer
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