The L Games STUDENT HEALTH FORM

Attention: Please note that your registration is not complete until the
Registration Form, Optional Activity, Health Form, and payment are submitted.

Name *
Name
Is the participant taking any medication? *
(If "No", enter "N/A")
Are there any physical restrictions? *
If "No", enter "N/A"
Hospital Insurance *
In Case of Emergency, Notify:
Name *
Name
Address *
Address
Phone *
Phone
Physician Phone *
Physician Phone

Attention: Please note that your registration is not complete until the
Registration Form, Optional Activity, Health Form, and payment are submitted.