2016学生健康声明书尽可能准确地回答下列有关方面的问题倘若在填写过程中有任何

LanguageLanguage健康声明书您的是否有以下方面的疾病、损伤或不良反应？请在合适的栏目内打勾

此一经签名，即证明本申请表上的所有内容均属实，同时也表示EF游学项目在必要的时候，在医生或专家建议下，为学生安排医疗服务，包括住院治疗等一切行为都已得到了您授权。其次，在学生范围以外所发生的医疗费用也将由您一并负责承担。另外，在必要情况下，您将会积极配合提供医生的英文，以证明您的子/女有良好的健康状况且也适合参加此项目。家长或监护人签名（18岁以下学生 日 日 FirstNameFirstName LastName CourseandStudentNumber MEDICALRELEASEANDCONSENTPleaseanswerthefollowinghealthquestionsasaccurayaspossible.IfyouhavedifficultycompletingthisforminEnglish,pleasecontactyourlocalEFofficeforassistance.Hasapplicanteverhadadisease,impairmentorabnormalityofthefollowing: EyesorEarsTonsils,NoseorThroatStomachorDigestiveSystemHasapplicanteversufferedfromanyofthefollowing?Indicatebycheckingtheappropriate ChickenEating

PleaselisttypesofallergiesanddescribetheIfyestoanyoftheabove,orifyourson/daughterhasanyothermedicalcondition,pleasegiveadetailedIsapplicantcurrentlytakinganykindofmedication,includingthosefor Ifyes,whatandHasapplicanteverbeenunderthecareofadoctorforanykindofpsychologicaldisorder? Ifyes,pleasedescribe.YoursignatureverifiesthattheinformationonthispageiscorrecttothebestofyourknowledgeandthatyouauthorizeEFEducation,anditsnel,toarrangefornecessarymedicaltreatmentforyourson/daughter,includinghospitalizationandanyemergencyoperation,whichisdeterminednecessarybyadoctororhealthcareprofessionalduringhis/herstayabroad.Youalsoacceptfullresponsibilityforanymedicalexpenseswhicharenotcoveredbyhis/herinsurance.Adoctor’sclearance/medical(inEnglishororiginalversion paniedbyEnglishtranslation)maybenecessarytoattestthatthestudentisingoodhealthandabletoparticipateintheprogram.Parent’sorguardian’ssignature(i