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Outdoor Lab Medical Form
All 6th grade students and high school leaders must have a medical form submitted by a parent/guardian in order to attend Outdoor Lab.
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* Indicates required question
Email
*
Your email
What is the password to access this form?
*
Your answer
Are you filling this out for a 6th grader or a high school leader?
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6th grader
High School Leader
STUDENT'S first name
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Your answer
STUDENT'S last name
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Your answer
STUDENT'S birth date
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MM
/
DD
/
YYYY
Parent/Guardian first and last name
*
Your answer
Parent/Guardian phone number
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Your answer
Parent/Guardian email
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Your answer
In the event we cannot reach the contact above, please list an emergency contact name and phone number.
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Your answer
Does your student have any medical conditions/concerns or a recent injury/hospitalization? If yes, please LIST ALL below. If none, type N/A.
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Your answer
Does your student have any activity restrictions or limitations? If yes, please LIST ALL below. If none, type N/A.
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Your answer
The following medications are available at both Mt Evans and Windy Peak and may be administered by the Outdoor Lab clinic staff when indicated. Check each medication that you give permission for the Outdoor Lab staff to administer.
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Acetaminophen
Ibuprofen
Benadryl
None
Required
Does your student have asthma?
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Yes
No
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