Department of Experiential Education 2026

1. Click ‘Get Form’ to open the Health and Medical Record in the editor.
2. Begin by entering your personal information, including your last name, first name, middle name, and birth date. Ensure accuracy as this information is crucial for emergency contacts.
3. Fill out the emergency contact section with the name and phone number of someone who can be reached in case of an emergency.
4. Indicate whether you have health insurance by selecting 'Yes' or 'No', and provide details about your health insurance company if applicable.
5. Rate your current level of physical activity by checking the appropriate boxes for activities such as walking, jogging, cycling, etc., along with how many times per week you engage in each.
6. Complete the medical history section by indicating any pre-existing conditions or past medical issues that may affect your participation.
7. Review all entries for accuracy before signing and dating the verification of accuracy and consent sections at the end of the form.

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