Ty Health Center if the participant should become ill or injured while on campus. FAX to 706-542-4959 prior to camp/program. Please note, there will be charges for services provided by the University Health Center. NAME DATE OF BIRTH HOME STREET ADDRESS CITY, STATE, ZIP CODE GENDER PROGRAM PHONE ( ) PROGRAM CONTACT PERSON PHONE ( ) PERMISSION FOR DIAGNOSTIC AND TREATMENT PROCEDURES I hereby authorize the.

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How to fill out the UGA Health Form For Summer Camps And Programs online

The UGA Health Form is a necessary document required for treatment at the University Health Center during summer camps and programs. This guide will provide clear instructions on completing the form online, ensuring you are prepared for any medical needs while participating in campus activities.

Follow the steps to successfully complete the UGA Health Form online.

  1. Click ‘Get Form’ button to obtain the UGA Health Form and open it in your preferred editor.
  2. Enter the participant’s name in the designated field at the top of the form.
  3. Fill in the date of birth and home street address, ensuring accuracy to avoid any issues in case of medical emergencies.
  4. Provide the city, state, and ZIP code for the home address.
  5. Select the gender of the participant from the options provided.
  6. Indicate the specific program the participant is enrolling in.
  7. Include the participant's phone number with area code.
  8. Complete the program contact person’s name and phone number for reference.
  9. Authorizing permission for diagnostic and treatment procedures: sign and date this section, ensuring it aligns with the participant’s age (over or under 18).
  10. List two contacts to notify in an emergency, including their names, relationships, addresses, phone numbers, and email addresses.
  11. Document the date of the last tetanus shot, any current medications, allergies to medications, and any chronic or significant medical conditions.
  12. Provide primary insurance information, making sure to include insurance company details and policyholder information, ensuring to attach a copy of the insurance card.
  13. Fill out the authorization to process insurance claims section, signing and dating as necessary.
  14. Review the form for accuracy, save your changes and download, print, or share the completed form as required.

Complete the UGA Health Form online to ensure you're ready for a safe and enjoyable summer camp experience.

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