Mission DR Application Form
Check the box(es) if any of the following apply to you: * Allergies (including drug) Dizziness or Fainting High Blood Pressure Physical Disability Asthma Epilepsy Operation in Last Year Regular Medication* Bee/Wasp Reaction Hay Fever Penicillin Allergy Respiratory Problems Diabetes Heart Trouble Pregnant Other
*Be sure to bring ample supply of your regular mediation with you on your trip. You may want to get a written prescription from your doctor to give to your group leader in case of emergency.