March of the Living 2023-2024 Application

Medical Form Part C: Medication and Mental Health
To be completed by Parent(s)/Guardian(s)
Physical Examination Form Upload due by
September 21, 2023.
Medical Form Part B & C due by
September 21, 2023.


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 complete all fields to the best of your ability.

*Denotes a required field


Please note: Participants who take medication on a regular basis will be responsible for that regimen during all travel and meeting times. The medical professional with the group during Miami's Leo Martin March of the Living is not responsible for dispensing medication on a regular basis. March staff members, other than a licensed medical professional, are not permitted to dispense medication of any kind; therefore, the participant must bring and be responsible for all of their own medication. If the participant requires medical attention beyond their regular routines they will see a licensed medical professional.

I agree


IMPORTANT NOTE: If your teen is on medication for emotional health issues, it is recommended that s/he be on the same medication/dosage for at least 1 month prior to and during the trip. Please provide additional information and notify us if there is any change.

Admin use only (do not edit)