Medical Form


The UM Office of Pre-College Programs seeks to provide a fun and safe experience for all students participating in our programming. This form grants permission to the Pre-College Programs staff and The University of Mississippi to seek medical treatment for a student in the event that any emergency or need to see a physician arises. This form with additional documentation is required for ALL students participating in a Summer Camp or Program and/or overnight events and one-day programs. Students lacking required paperwork will NOT be allowed to participate in the event, camp, or program for any reason.

Required Additional Documentation for Participation

In addition to completing the Medical Form, you will also need to attach the following documentation.

  • Copy of Student Insurance Card (front and back) or Waiver of Health Insurance (included in Medical Form packet)
  • Copy of Parent/Guardian Driver’s License or state-issued ID (front and back)

The Medical Form and additional documentation should be either be uploaded using the link below or mailed to the address listed on the form. *For information security, please do not email the medical form and additional documentation.

Medical Form (printable version)

Questions/Concerns/Troubles: Please contact the Office of Pre-College Programs at 662-915-7621 or email