Participant Medical Form

 
  • Youth Challenge activities are designed to serve children and young adults (up to age 25) with physical disabilities. Individuals must have a physical disability (i.e. cerebral palsy; spina bifida; muscular dystrophy; amputee, orthopedic, visual or hearing impairment) and must be able to participate in age-appropriate activities. Youth Challenge currently does not serve children with a transmittable disease, or children who have a cognitive, behavioral, or emotional disability that prevents them from succeeding in Youth Challenge programs.
  • PARTICIPANT INFORMATION

  • PARENT / GUARDIAN INFORMATION


  • EMERGENCY CONTACT (other than primary guardian/contact)

  • Medical Insurance; Statement of Present Health:

  • Personal Care Needs

  • Emergency Instructions

  • Medical Verification

 

Verification