Medical Form Part A -Email – Miami March of the Living

March of the Living 2024-2025 Application

Medical Form Part A: Examination Form Upload

To be completed by Parent(s)/Guardian(s)

Physical Examination Form Upload due by

October 1, 2024.

Medical Form Part B & C due by

October 1, 2024.

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Your teen is applying to participate in Miami's Leo Martin March of the Living program. Miami’s March of the Living is a year-long identity-building program that uses Poland and Israel as a platform to study the history of the Holocaust and examine the roots of prejudice, intolerance, and hatred. Click Here for the program calendar for you to review to ensure your child can participate fully.

In order for their application to be complete, you, as the selected parent/guardian must complete the medical portion of the application. Part B & C should take you about 10 minutes to complete. We suggest using a computer and not a phone to access the form.

There are three parts of the medical paperwork:

Medical Form Part A - Physical Examination Form Download and give to physician and Upload the completed form
Medical Form Part B
Medical Form Part C

Please note that it is extremely important that you provide us with complete information about your teen's medical and psychological history. This information is vital to ensure your teen's safety and well-being. Please take the time to complete this form accurately and thoroughly. Omissions can be serious for the individual and can affect the entire group.

All information will be kept strictly confidential by Miami's March of the Living staff and will only be referenced or shared with others to assist in ensuring the physical, psychological, and emotional well-being of your teen.

Please print the physical medical examination form by CLICKING HERE

This form must be completed by the teen’s physician or nurse practitioner and returned by the due date

Please note that your application will remain incomplete until this form is submitted.

Please scan and upload the document below once it is completed.

Be sure to enter your teen's email address below exactly how it appears in the email you received.

Registrant(Teen) Email Address^*

Before uploading your Medical Form Part A, please rename the file with the teen's full name. Example: john_smith_medforma.jpg

I agree to enroll in Miami’s Leo Martin March of the Living Program, a highly intensive Jewish educational experience, to participate fully in all its aspects and to abide by its rules and regulations. I acknowledge the fact that usage or involvement with alcoholic beverages, drugs or narcotics, or any other type of anti-social behavior including failure to abide by its rules and regulations may be cause for my immediate dismissal from the program and my return to the United States at my own expense.^*

Yes, I agree
No, I do not agree

On the Medical Form enclosed, I have read the notes to the Examining Physician. I hereby certify that the Medical Form is complete in detail and fully realize that any condition, mental or physical, that is found to have originated prior to my departure, and which is not described in full on this form or in an accompanying letter submitted prior to departure, will be due cause for my return or treatment in the country I am visiting at my expense and that the March of the Living and its representatives have neither responsibility nor liability arising out of such condition. Furthermore, all medication that I take regularly is detailed in the Medical Form or accompanying letters.^*

I acknowledge

Medical Examination Form^*

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