March of the Living 2022-2023 Application

Medical Form Part A: Medical Information
To be completed by Parent(s)/Guardian(s)
Medical Form Part A & B due by November 16th. 
Physical Examination Form Upload due by January 2nd.

    
     
   

Your teen is applying to participate in Miami's Leo Martin March of the Living 2022-2023 program. Miami’s March of the Living is an 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 A & B 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: 

  1. Medical Form Part A
  2. Medical Form Part B
  3. Physical Examination Form Download and give to physician 
  4. Physical Examination Form Upload the completed form

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 wellbeing. 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 wellbeing of your teen.

Please complete all fields to the best of your ability.

*Denotes a required field

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


GENERAL INFORMATION

PERSONALITY

SLEEPING HABITS

EATING HABITS

MEDICAL HISTORY AND CURRENT INFORMATION