2026 Medical and Insurance Information: Students

2026 NCF-Envirothon Mississippi Competition
Dates: July 19 - 25, 2026

NCF-Envirothon is committed to respecting the privacy of our students, advisors, and guests. The information provided below will remain confidential and only shared with key individuals (i.e., legal guardians, team advisor/chaperone, emergency contact, medical personal, etc.) in the case of medical emergencies or illness.

Medical and Insurance Information: REQUIRED by ALL Student Team Members, Advisors, Chaperones, and Guests attending the 2026 NCF-Envirothon Mississippi Competition.

Deadline: June 5, 2026 ¹

Please Note:
- • A Parent or Legal Guardian will be needed to complete this form if the student team member participant is under the age of 18.
- • Proof of Medical Insurance is Required ² - An electronic copy (picture or scan) of the attendees Medical Insurance information (card) should be uploaded to this form (follow the directions below). Please have a scan or photo of the front and back of the medical insurance card available in order to proceed.
¹ Student Team Members, including Team Substitution Candidates, Advisors/Chaperones, and Guests from Maine, Ohio, and Maryland have 7 days from the conclusion of their state/provincial Envirothon competition to complete all Required Registration Forms:
a. Maine - due on June 9
b. Ohio - due on June 12
d. Maryland - due on June 22

² For individuals not currently covered under any health insurance plan, a temporary limited policy (such as 'travel medical insurance', can be obtained to cover the timeframe of the competition. A minimum of 7-14 days is recommended to cover all travel to and from the event location as well as the 6-days of the competition itself.
State, Province, or Partner Nation of Student Participant: *
Name of Student Participant: Name of Student Participant: * First Last
Student's Email *
Attendee is registered as a: *

Attendee is registered as a: Student Team Member Team Substitution Candidate
Student's: Please enter your Team Advisor's email correctly. They will recieve email confirmation that your form has been successfully submitted, but will NOT see your entered data.
Team Advisor's Email

Confirm Email Address
Student's Address Student's Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student's Date of Birth Student's Date of Birth * / MM / DD YYYY
Is the participant currently 18 years of age or older? *

Is the participant currently 18 years of age or older? Yes No
Student's Parent/Legal Guardian

Reminder: If the student is under the age of 18, a Parent or Legal Guardian will be needed to complete the form.
Parent/Legal Guardian Name Parent/Legal Guardian Name First Last
Parent/Legal Guardian Home Phone Parent/Legal Guardian Home Phone - ### - ### ####
Parent/Legal Guardian Cell Phone Parent/Legal Guardian Cell Phone - ### - ### ####
Parent or Legal Guardian Email

Confirm Email Address
Emergency Contact (E.C.) Information

-> Parent, guardian, relative, or other that will be contacted in the case of a medical emergency.
E.C. Name E.C. Name * First Last
E.C. Cell Phone E.C. Cell Phone * - ### - ### ####
E.C. Home Phone E.C. Home Phone - ### - ### ####
E.C. Work Phone E.C. Work Phone - ### - ### ####
E.C. Email
Relationship to Student *
Additional Emergency Contact(s): Please provide name, contact #s, and relationship status to student
(Optional)
MEDICAL INFORMATION
Gender of Student *

Gender of Student Male Female Self Describe Self Describe

Please identify any health issues the student may have that could reoccur during the event or influence any medical treatment: *
	Yes	No
Asthma	AsthmaYes	AsthmaNo
Diabetes	DiabetesYes	DiabetesNo
Food-based Allergy	Food-based AllergyYes	Food-based AllergyNo
Medication-based Allergy	Medication-based AllergyYes	Medication-based AllergyNo
Environmental-based Allergy	Environmental-based AllergyYes	Environmental-based AllergyNo
Allergy to latex	Allergy to latexYes	Allergy to latexNo
Physical Disability	Physical DisabilityYes	Physical DisabilityNo
Epilepsy or other seizure condition	Epilepsy or other seizure conditionYes	Epilepsy or other seizure conditionNo
Other	OtherYes	OtherNo

If you selected 'Other', please list below:
Food-Based Allergies

Please list all food-based allergies (eggs, dairy, fish, shellfish, wheat, soy, gluten, sesame, etc.) *
Medication-Based Allergies

Please list all medication-based allergies (antibiotics, sulfa drugs, aspirin, etc.) *
Other Allergies

Please list any other allergies we should be aware of in the event of an emergency (severe reactions to insect bites and stings, animal dander, latex, etc.)
Special Accommodation

If you have a disability or special need and may require accommodations in order to fully participate or be treated in case of emergency, please indicate below:
Medications

Please list all Medications you are taking that medical personal should be aware of in the event of an emergency *
Physician/Medical Provider Information
Physician's name and/or name of Medical Practice where your medical history is kept: *
Physician's Phone Number Physician's Phone Number * - ### - ### ####
INSURANCE INFORMATION - REQUIRED

Per the NCF-Envirothon Annual Competition Rules and Regulations, each individual in attendance must provide proof of health insurance.
- • You will be asked to upload an electronic copy of the front and back of the student's medical insurance card to complete this form.
-> For individuals not currently covered under any health insurance plan, a temporary limited policy (such as 'travel medical insurance') can be obtained to cover the timeframe of the competition. A minimum of 7-14 days is recommended to cover all travel to and from the event location as well as the 6-days of the competition itself.
Name of Insurance Company *
Insurance Company Phone Insurance Company Phone * - ### - ### ####
Primary Card Holder Name on Insurance Policy
(self/parent/legal guardian) Primary Card Holder Name on Insurance Policy
(self/parent/legal guardian) * First Middle Last
Primary Card Holder Email *
Proof of Insurance - Card Upload
- • PDF, JPG, TIF, PNG, or GIF are preferred file formats.
* Uploaded copies of Insurance information, will be deleted upon conclusion of competition.
Front of Insurance Card or Proof of Insurance Document

Attach Files
Back of Insurance Card

Attach Files

2026 Medical and Insurance Information: Students

2026 Medical and Insurance Information: Students

Student's Parent/Legal Guardian

Emergency Contact (E.C.) Information

MEDICAL INFORMATION

Physician/Medical Provider Information

Proof of Insurance - Card Upload • PDF, JPG, TIF, PNG, or GIF are preferred file formats.

Proof of Insurance - Card Upload

• PDF, JPG, TIF, PNG, or GIF are preferred file formats.