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I am traveling with:
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American Citizen *
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Emergency Contacts
Please provide full and accurate information for every field.
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Do you have medical insurance? *
*Note: You must have medical insurance to participate in any travel through the University. If you do not have insurance you may purchase it through Student Accounts.
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Are you currently taking any medications, including over-the-counter medications? *
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Any Travel Participant going abroad with any preexisting medical problems should carry a letter from the attending physician, describing the medical condition and any prescription medications, including the generic name of prescribed drugs. Any medications being carried overseas should be left in the original containers and be clearly labeled. The Travel Participant should check with the foreign embassy of the country being visited to make sure any required medications are not considered to be illegal narcotics.
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HEALTH STATEMENT
Please indicate past or present illnesses or conditions:
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Do you have any food allergies? *
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Have you been treated in the last three years for any mental or emotional condition or regarding mental health, including counseling? *
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Are you currently on any drug for treatment of mental or emotional condition? *
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ORU Student Life Department, including but not limited to the offices of ORU Missions, Spiritual Life, and ORU Counseling, reserve the authority to determine if any missions trip might be unsafe for a student due to his or her fitness for participation, including mental health and physical ability, in order to improve the quality of their ORU Missions experience and to help keep them safe on and off the field. Please communicate to the ORU Missions & Outreach Directors if you have any conditions that might affect your ability to participate in the trip you have been placed on.
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To the best of my knowledge, the above information is complete and correct.
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I understand this is a legal representation of my signature.
Clear
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