2016學(xué)生健康聲明書盡可能準(zhǔn)確地回答下列有關(guān)方面的問題倘若在填寫過程中有任何

LanguageLanguage健康聲明書您的是否有以下方面的疾病、損傷或不良反應(yīng)？請?jiān)诤线m的欄目內(nèi)打勾

此一經(jīng)簽名，即證明本申請表上的所有內(nèi)容均屬實(shí)，同時(shí)也表示EF游學(xué)項(xiàng)目在必要的時(shí)候，在醫(yī)生或?qū)＜医ㄗh下，為學(xué)生安排醫(yī)療服務(wù)，包括住院治療等一切行為都已得到了您授權(quán)。其次，在學(xué)生范圍以外所發(fā)生的醫(yī)療費(fèi)用也將由您一并負(fù)責(zé)承擔(dān)。另外，在必要情況下，您將會(huì)積極配合提供醫(yī)生的英文，以證明您的子/女有良好的健康狀況且也適合參加此項(xiàng)目。家長或監(jiān)護(hù)人簽名（18歲以下學(xué)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