Medical Information and Emergency Contact Form
Please complete the form below in full. The more information you provide, the more we can care for you during the program. Failure to disclose pertinent medical information to Compass may result in injury or mishap otherwise preventable.
All information provided on this form is confidential and will be viewed only by Compass staff.
Compass requires two emergency contacts for every participant. Emergency contacts can not also be trip participants.
NOTE: By signing your name electronically at the end of this form, you agree that your electronic signature is the legal equivalent of your manual signature. If the participant is under the age of 18, a parent/guardian should be the one to fill out and sign this form.
Compass Medication Policy
Compass requests that participants disclose any and all regular prescriptions, over-the-counter meds, vitamins or supplements being taken while on the program on this medical form. This is not to pry unnecessarily into my private life or medical history, but so that Compass has a record of any medications in my system and can provide this info to relevant health officials in the event of a medical emergency during the trip. Please know that you are not mandated to disclose my medical conditions/medications to Compass, but opting out of doing so indicates an understanding that Compass may not be able to properly assist you in the event of a medical emergency or make any accommodations pertinent to any undisclosed medical conditions.
In order for a participant to use prescribed medication during Compass, they must ensure they are storing the medication in the original container with a pharmacy label identifying name, drug, dosage (be specific), time medication should be given and physician’s name. If not stored in the original container (i.e. in a pill distributor or planner), participants are asked to carry a copy of the prescription.
All participants aged 18 and older will carry and self-administer their medications. A program leader will carry and administer all medications for any participants aged 17 and younger.
All participants need to inform Compass of any pertinent changes (injuries, medications, allergies etc.) to their medical information that happen between the time the form was submitted and the start of the trip.