Participant Medical Information

Medical Information Forms

The University of Michigan requires four standardized forms to be completed for each youth participant (17 years and younger) attending your program. Obtain these forms from Dale Bahr, Assistant Director, Athletics.

• Parental Consent and Release of Liability Agreement (includes authorization for medical treatment)

• Health Insurance Information Sheet

• UM Summer Camp Health Questionnaire

• Physical Examination Information

It is critical that Department of Public Safety and University Housing Security officers have quick access to these medical information forms. This is especially important in the evening, weekend or nighttime hours. Trainers should hold these. In the event of an emergency, the responding officer would have access to the forms to send to the hospital or treatment center. U-M Risk Management and the Office of the General Counsel have reviewed and approved these medical and liability forms.

Medication

Authorization to dispense medication must be given by the parents or guardians. Information must include:

• The name of the medication.

• The dosage of the medication.

• The name and telephone number of the prescribing physician. The telephone number of the physician must be on record.
  

Need Medical Information Forms?

You may download the forms here.

Questions?

If you have any questions about the medical information forms or the process, please contact:

Kate Rychlinski
U-M Risk Management
734.764.2200