Health Form

This form is REQUIRED for: • SINGERS • PIANISTS • INSTRUMENTALISTS • FACULTY/STAFF • VISITORS
We urge you to determine the status of your health prior to traveling to Saarburg. If you are under treatment for a medical or surgical condition, please obtain clearance from your doctor to participate in Saarburg International Festival & School.

Here is an example of required electronic signature for the applicants under the age of 18:

John Smith/Jane Rice for Philip/Lauren Smith/Rice (piano)

MEDICAL INFORMATION STATEMENT: The information I provide regarding my health and recent medical history will be accurate and complete to the best of my knowledge. I understand that it is confidential and to be used only to help me while in Saarburg. I will not hold SAARBURG FESTIVAL or its agents responsible for errors or omissions I may have made in the completion of my recent medical history. I will promptly inform the Saarburg Festival staff should there be a change in the status of my health or well being while I am at Saarburg.(required)

I ACCEPT

Read the Emergency Treatment Statement below to give approval for Saarburg Festival to seek medical care in case you are unable to give permission for treatment at the time of an emergency. EMERGENCY TREATMENT STATEMENT: I hereby authorize Saarburg Festival and/or its agents to obtain medical and surgical treatment on my behalf in the event of an emergency during Saarburg Festival & School. By clicking on Accept or Don’t Accept in the Saarburg Festival Registration questionnaire, I agree that electronic transmission of my permission is legally binding.(required)

I ACCEPT

ELECTRONIC SIGNATURE of Applicant or Guardian (required of all applicants) Participants less than 18 years old: Please have a parent or guardian provide an electronic signature on your behalf (please indicate the name of the student you sign the form for and instrument).(required)

Date(required)

Email(required)

Share this:

Like this: