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Medical & Insurance Information and Release
Reminder: If the participant is under the age of 18, a Parent or Legal Guardian will be needed to complete the form.
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Participant is attending the 2022 NCF-Envirothon Ohio competition as a: *
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Is the registered participant 18 years of age or older? *
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Gender *
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Emergency Contact Information
(Parent, guardian, spouse, relative or other that will be contacted in the case of a medical emergency)
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Registered Participant - Medical Information
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Special Dietary Needs Statement:
Miami University's Food and Beverage team is committed to providing guests with an exceptional on-campus dining experience that takes into consideration guest dietary needs, lifestyle choices, cultural backgrounds, and religious affiliations.
On campus dining offers a variety of options for students and guests in each dining location. Their menus are designed to include those who avoid gluten and nuts, have a dairy allergy or intolerance, as well as those who follow a vegan and vegetarian diet.
Additionally, in each dining location Miami University utilizes allergen icons to indicate the major eight allergens (eggs, dairy, fish, shellfish, wheat, soy, gluten, sesame) as well as pork, poultry, beef, vegan, and vegetarian. These can be seen on the menu boards for each served item.
If you have dining accommodation need that exceeds the offerings listed above, you are asked to fill out a 'Self-disclosure Dietary Needs Form'. Once submitted, a Miami University Registered Dietitian will contact you for further discussion regarding your dining accommodation needs.
Please ONLY submit a form if your dining need is such that the standard Miami University Dining Options will not suffice!
Envirothon students and/or guests should submit their self-disclosure dietary request form at least two weeks prior to arrival on campus. Please understand that there may be a considerable time commitment involved in working out the details of your dining accommodation needs.
Planning ahead and communicated with Dining Services is essential and entirely up to the individual requesting services. NCF-Envirothon is NOT responsible for contacting the Miami University Registered Dietitian on your behalf and will not be involved in special dietary needs requested through their 'Self-disclosure Dietary Needs Form' portal.
For more information on Miami University's Dining Accommodations, please click here.
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By checking the following boxes and providing my signature, I certify that: *
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Insurance Information
As part of the NCF-Envirothon annual international competition, each individual in attendance must provide proof of health insurance. For individuals not currently covered under any health insurance plan, a temporary limited policy 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.
Please make sure you have an electronic copy of the front and back of the individual's medical insurance card to complete this form.
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Insurance Card Upload
PDF, JPG, TIF, PNG or GIF are preferred file formats
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Medical & Insurance Information and Release Confirmation
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Registered Participant Approval *
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I understand this is a legal representation of my signature.
Clear
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Parent/Legal Guardian Approval
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I understand this is a legal representation of my signature.
Clear
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