Medical Release Form for Florida

Please print this form and complete it.  Attach a photocopy of both the front AND the back of your health insurance card.  If you have multiple family members attending, please complete one for EACH traveler, including a copy of the insurance card.  Please return to Mr. or Mrs. Kazin by WEDNESDAY, JANUARY 31ST.

 

In addition, all chaperones must complete a background check, including fingerprinting, before traveling.  Please contact Sheri Sochacki at ssochacki@evergreenpark.org for more information.  The background check takes time to process, so please begin this process as soon as possible.

Medical release and insurance form