Ivy Tech Community College of Indiana HEALTH INFORMATION 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Participant Information' section. Enter the program attending, program dates, participant's name, date of birth, gender, and age.
3. In the 'Medical History' section, provide details about any allergies, chronic diseases, current medications with dosages, and any physical restrictions your child may have.
4. Complete the 'Family Doctor Information' by entering the doctor's name and phone number.
5. Fill in the 'Parent/Legal Guardian Information' with names, addresses, phone numbers, and emails for both guardians.
6. List additional emergency contacts who can be reached if a legal guardian is unavailable.
7. Specify authorized individuals who are allowed to pick up your child. Ensure that you include their names clearly.
8. Review the 'Release of Information', 'Permission for Treatment', and 'Assumption of Risk' sections carefully before signing. Ensure all information is accurate.
9. Finally, sign and date the form at the bottom where indicated by a legal guardian's signature.

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