Society Of American Military Engineers Medical Release printable pdf download

Society Of American Military Engineers Medical Release

MEDICAL RELEASE FORM

Society of American Military Engineers

Engineering & Construction Camp

A recent medical release form or physical fitness report completed for high school

sports or another related activity requiring the student to be physically fit may be

substituted for this form.

Otherwise, please have your physician fill out the information below and sign the

form.

PHYSICIAN PLEASE NOTE - Students must meet the following criteria in order

to attend camp:

 Be physically fit and healthy (i.e. not be dependent on medical care or treatment that would

be difficult to administer in a field environment);

 Not have any physical limitations including, but not limited to the following: a requirement to

take mandatory medication that requires special handling; sprained joints; or, neck, shoulder,

or back injuries.

Student’s Name (please print clearly):_______________________________

The above patient is medically cleared to fully participate in all camp activities.

_____________________________________

Physician’s Name (please print clearly)

_____________________________________________

Physician’s Signature

Date _________________________________________

STUDENTS – This signed form must accompany your application to attend camp.

12/29/04

Society Of American Military Engineers Medical Release