Student Event Forms


Student Medical Information Form



Please fill out the form below if your student is attending an upcoming
ClearView Student Ministry event.

This form will be kept on file from August 2017-July 2018.

Contact Beth Newlin with any questions.

Student Information

Parent(s)/Guardian Information

Emergency Contact (other than Parent(s)/Guardian)

Medical Information

If you have an electronic copy or photo of your insurance card, please attach it below. Please contact the Student Ministry Team if you need to make a paper copy.

  • Insurance Card Front
  • Insurance Card Back

Please answer the following questions for your student...

  • Does your child have allergies to:
  • Does your child have a history with any of the following:

Every Student Ministry event has a time for parents to check-in their students. At that time, parents should bring any prescription medications their student is taking, with instructions, to be turned into the Student Ministry Team for the duration of the trip.

Over The Counter Medications

Please check over the medications that may be administered by an adult chaperone to your student. All medications will be administered in accordance with the manufacturer's recommendations bases on weight and age.

  • Over The Counter Medications: