2024 Campus Life Medical Information
This form is to cover all medical information for your high school student for the rest of the 2024 SCHOOL year. Once this form is completed, your student will be covered for all trips and events with Lansing Campus Life from the date of completion until August 31, 2024.

For our bigger trips (Florida Spring Break, Smokies, Wisconsin Dells, etc.), a packing list and an information sheet will be sent to your occupancy.

Campus Life will only use this medical information in cases of emergency OR meal-planning.

If your medical information changes during the year, please return to this page and update your information.

* THIS FORM MUST BE COMPLETED BEFORE YOUR STUDENT CAN PARTICIPATE IN ANY CAMPUS LIFE EVENT OR TRIP!
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Email *
Are you filling this information out for the first time or updating? *
Parent/Guardian Name: *
First and Last
Parent/Guardian Address, City, AND Zip Code  *
This is where our city-wide trip information (such as Florida) will be sent to, including the email given at the beginning of this form. 
Parent/Guardian Phone Number *
Student's Name: *
First and Last
Student's Phone Number: *
** If your student does not have messaging capabilities via phone number/imessage please type the best way to contact the student. 
Student's Birthday *
MM
/
DD
/
YYYY
Campus Life Club (that your child attends)  *
Lansing includes Eastern, Everett, Lansing Catholic, and Sexton High Schools.
School (regardless of the club they attend)  *
Gender *
Student's Address, City, AND Zip Code 
* If the same as the parent/guardian address just type "No Change" 
 *
Insurance Co. *
If none, type none.
Policy # *
If none, type none.
Any Medical Conditions? *
If none, type none.
Any Medications that must be taken? *
If none, type none.
Any Allergies? *
If none, type none.
Any Dietary Restrictions? *
Vegan, Vegetarian, Gluten Free, etc.
EMERGENCY CONTACT *
Relationship *
Emergency Contact's Phone Number *
Reminders for Registering for Trips
This form is to cover medical information for your high school student from the time of completion to August 31, 2024. Unless your medical information changes during that time, we require that you fill out this information only once per school year.

Please note that in order to be signed up for a trip or an event with Campus Life, this form, the trip's or event's permission slip, and the required payment must be submitted in order to save your student's spot.

Payments & Permission Slips can be completed online at http://lansingyfc.net/cl-trips-events

Checks can be made out to Lansing Campus Life and sent to:

5222 Dumond Ct.
Lansing, MI 48917
Parent/Guardian Signature
 *
A copy of your responses will be emailed to the address you provided.
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