Get Delegate Health Form (pdf) - Missouri 4-h

Filling out the Delegate Health Form is essential for participating in events like the National 4-H Congress. This guide will provide you with clear and supportive instructions to ensure that your form is completed accurately and submitted online.

Follow the steps to successfully complete your Delegate Health Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the name of the delegate in the designated area, including last, first, and middle names.
3. Next, provide the birth date of the delegate by selecting the month, day, and year in the corresponding fields.
4. Indicate the delegate's gender by marking the appropriate box.
5. Enter the home address, including the number and street or P.O. Box, city, state, and zip code.
6. Fill in the details of the parent or guardian, including home phone, cell phone, and work phone.
7. Provide information for an alternate emergency contact, including their name and phone number.
8. In the opinion statement, indicate the delegate's capability to participate by checking the correct health status (poor, fair, good) and crossing out the inapplicable words.
9. The parent or guardian must sign the form to give permission for medical treatment in case of an emergency.
10. Proceed to page 2 of the form and answer the health questions by marking 'yes' or 'no', providing additional details if 'yes' is selected for any conditions.
11. List any medications currently being taken by the delegate, including name and doses, and provide the date of the last flu shot and tetanus booster.
12. Indicate any special needs or concerns, attaching an additional page if more space is necessary.
13. Once all sections are completed, ensure to save your changes and prepare the document for downloading, printing, or sharing as needed.

Complete your Delegate Health Form online to ensure smooth participation in Missouri 4-H events.