Western Illinois University: Macomb Campus
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Medical Information and Required Participation Forms
In order to provide for the health and well-being of each participant during our programs, we ask that parents provide medical information and a recent copy of their prescription/medical insurance card to our office. In the event of an accident or visit to the hospital, this information will aid us in expediting medical care.
Please read, sign, and return the following notice and permission forms prior to the program start date. Please Note: If you need any forms in an alternate format, or need assistance, please contact our office at 309.298.1911, or toll-free at 866.933.8964.
MDH Notice of Privacy Practices (PDF)
MDH Required Signature Page (PDF)
Authorization to Treat a Minor (PDF)
Beu Notice of Privacy Practices (PDF)
Western Medical Form (PDF)
Beu Parental Permission Form (PDF)
Photo Permission Form (PDF)
Transportation Waiver (PDF)
Behavioral Contract (PDF)