Discover Healthcare Summer Camp - Memorial Health SystemMemorial Health System

General Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student's Email*

Student's Phone*

Parent/Guardian Email (Optional)

Parent/Guardian Phone*

High School Attending*

Current Year in School*

Medical Information: Are you able to provide proof of the following if selected?*

Proof of two doses of MMR vaccine
Proof of three doses of Hepatitis B vaccine
TB Skin Test completed within the last 12 months

If you are selected, what size of scrub top would you wear?*

Please write a short essay (one or two paragraphs) explaining why you want to participate in the Discover Healthcare High School Summer Camp. Be sure to write about why you’re interested in the healthcare profession.*