Get the free Jr. Clinic Enrollment Application- Summer 2013

Jr. Clinic Enrollment Application Summer 2013 Player Name Sectional Camp(circle one) Session 1: 6/106/13 Tournament Training: (circle one) Session 2: 6/176/20 TT1/1.5 (11am2pm) TT2/2.5 (9am11:30am)

How to fill out jr clinic enrollment application

How to fill out a jr clinic enrollment application:

1. Obtain the application form: Contact the jr clinic or visit their website to obtain a copy of the enrollment application form.
2. Provide personal information: Start by filling in your personal details such as your full name, date of birth, address, and contact information. Make sure to double-check the accuracy of this information.
3. Health insurance information: Indicate whether you have health insurance coverage and provide the necessary details, including the name of the insurance company and your policy number.
4. Medical history: Fill out the section related to your medical history. Be thorough and provide details about any pre-existing conditions, allergies, medications you are taking, and any previous medical treatments or surgeries.
5. Emergency contact information: Include the contact details of a person to be reached in case of an emergency. Ensure that you have their full name, relationship to you, phone number, and preferably an alternative contact person as well.
6. Consent and waivers: Read through all the consent forms and waivers provided in the application carefully. Sign and date where required, acknowledging that you understand and agree to the terms and conditions stated.
7. Additional documents: Some jr clinics may require additional documents to be submitted along with the application. These may include proof of identity, medical records, proof of insurance, or any other documents specified by the clinic. Make sure to gather and attach these documents as instructed.
8. Submission: Once you have completed the application form and attached any required documents, submit it to the jr clinic through the designated method. This may include mailing it, hand-delivering it, or submitting it online through their website.

Who needs a jr clinic enrollment application:

1. Individuals seeking medical services: Anyone who wishes to receive medical services from the jr clinic, whether it is for routine check-ups, treatment of an illness, or specific healthcare needs, needs to fill out a jr clinic enrollment application.
2. Minors: If you are a parent or legal guardian, you will need to fill out the enrollment application on behalf of your minor child. This is necessary to provide accurate medical information and consent to medical treatment.
3. New patients: Even if you have received medical services from the jr clinic in the past, you may need to complete a new enrollment application if there have been any changes to your personal information, insurance coverage, or medical history.

Please note that the specific requirements and procedures may vary depending on the jr clinic. It is always recommended to carefully read the instructions provided with the application form or contact the clinic directly for any clarification.

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