Health Information: All fileds are required. (Please put "NONE" to skip).
Any activity the applicant should be restricted from?*
_______________________________________________________________________________________
Any physical, mental or other condition that would require special attention or medication?*
_______________________________________________________________________________________
List any past medical treatments/surgery:*
_______________________________________________________________________________________
List any allergies:*
_______________________________________________________________________________________
Any dietary needs?*
_______________________________________________________________________________________
List all medications, both prescribed and over the counter:
_______________________________________________________________________________________
**(All medications will be turned into the health officer except rescue inhalers. Bring all necessary medication in the original containers).**