Medical Health Questionaire
TRIP LOCATION: HAITI
TRIP DATE: October 5 - 11, 2019
In the event that an emergency arises, I give the trip leader permission to authorize anesthesia, surgery, and/or procedures deemed absolutely necessary at the time.
NOTE: Parent or Legal Guardian’s signature if you are single and under 18 (or under 19 and reside in AL, NE, WY; or under 21 and reside in CO, MS, WV, PA PR).