Tour Medical Forms

Please complete the forms below. If you have any questions, comments, or concerns, please email colker@georgiaboychoir.org

1. Chorister Information
Name *
Name
Date of Birth *
Date of Birth
(lbs)
2. Emergency Contact Information
Parent Contact #1 *
Parent Contact #1
Emergency Contact Information
Home Address *
Home Address
Cell Phone *
Cell Phone
Home Phone *
Home Phone
Work Phone *
Work Phone
Parent Contact #2 *
Parent Contact #2
Emergency Contact Information
Home Address
Home Address
Complete only if different than address above.
Cell Phone *
Cell Phone
Home Phone
Home Phone
Work Phone *
Work Phone
If you will be traveling while we are on tour, please indicate where and whom we should contact in the event of an emergency.
2. DAILY or AS-NEEDED Medications to be taken on tour
Please place medications in a ziplock bag labeled with your son's name and bring to rehearsal on Monday, May 15th.
Please list PRESCRIPTION and OTC medications in the following format: Medication - How to administer - Dosage - Schedule - Purpose
Please list PRESCRIPTION and OTC medications in the following format: Medication - How to administer - Dosage - Schedule - Purpose
Please list any specific information, instructions, concerns, or side-effects related to these medications.
3. OTC Medication Permission
These over-the-counter medicines will be provided by The Georgia Boy Choir and carried in a medical bag at all times. PLEASE do not send with your son. Select the OTC Medication to be administered by The Georgia Boy Choir not on a routine basis.
For PAIN or FEVER
Ibuprofen - Form *
Select all forms your son can receive.
Please enter dosage amounts below. Please specify units of measurements as "##mg," "##ml," etc. NOT as "# pill," "# tablet," etc. Thank you!
For PAIN or FEVER
Tylenol - Form *
Select all forms your son can receive.
Please enter dosage amounts below. Please specify units of measurements as "##mg," "##ml," etc. NOT as "# pill," "# tablet," etc. Thank you!
For ALLERGIC REACTION or RASH
Benadryl - Form *
Select all forms your son can receive.
Please enter dosage amounts below. Please specify units of measurements as "##mg," "##ml," etc. NOT as "# pill," "# tablet," etc. Thank you!
For ALLERGIC REACTION or RASH
For ALLERGIC REACTION or RASH
For STOMACH PAIN/Indegestion
Please enter dosage amounts below. Please specify units of measurements as "##mg," "##ml," etc. NOT as "# pill," "# tablet," etc. Thank you!
For DIARRHEA
Imodium - Form *
Select all forms your son can receive.
Please enter dosage amounts below. Please specify units of measurements as "##mg," "##ml," etc. NOT as "# pill," "# tablet," etc. Thank you!
Please list all allergies and reactions
4. Medical History
Health History
Please CHECK all boxes that apply. Then provide extra necessary information in the text box below.
Please provide any necessary information on the above CHECKED boxes
Please list all allergies and reactions
Please list all surgeries and dates
Please list diseases, disorders, injuries, syndromes, and abnormal health situations that may require treatment or attention from chaperones or staff

If you have any questions, comments, or concerns, please email colker@georgiaboychoir.org

Thank you!