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MCJROTC HEALTH RISK SCREENING QUESTIONNAIRE
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* Indicates required question
Cadet Last Name, First Name
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Your answer
Part A – TO BE COMPLETED BY THE CADET AND PARENT/GUARDIAN Directions: Please read ALL of the below questions and answer Yes or No (Do not leave any questions blank)
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Yes - Please provide question number and explain below.
No. *By checking this box you are selecting 'No' to ALL the above questions.
If you answered 'Yes' to any of the above questions please provide the question number and explain here.
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Your answer
My cadet is released for participation in all physical activities. **Select only one**
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Yes
No
Required
Cadet Typed Signature
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Your answer
Date
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MM
/
DD
/
YYYY
Parent Typed Signature
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Your answer
Date
*
MM
/
DD
/
YYYY
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