Summer Studio Enrollment Form Step 1 of 4 25% We are so excited that you will be joining us this summer! This form might take some time to complete, as there are forms to sign, and a couple of other activities, but it will make starting our summer even smoother. So thank you, and we can't wait to meet you! Let me know if you have any issues with this form by emailing summer@100foldstudio.org.Name* First Last Email* Medical Information This information will not affect program participation (unless medically necessary to adjust), but allows us to ensure a continuity of care to the best of our ability.Immunization RecordMax. file size: 8 MB.Medical History: Have you ever had any of the following?* Anemia Asthma Back Problems Broken Bones Diabetes Dislocation of Joints Ear Trouble Epilepsy Eye Trouble Fainting Spells Gallbladder Problem Head Injury Heart Trouble Hepatitis High Blood Pressure Insomnia Intestinal Troubles Jaundice Kidney Disease Low Blood Pressure Mental or Nervous Disorders Paralysis Recurrent Diarrhea Recurrent Headache Rheumatism/Arthritis Shortness of Breath Skin Condition Stomach/Duodenal Ulcer Tumor/Cancer Venereal Disease Irregular Periods Severe Cramps Excessive Menstrual Flow Pregnancy None of the Above If yes, please describe as necessary:*List any allergies you may have (and describe severity/reactions):*Have you ever been tested for HIV?* Yes No If yes, what was the outcome?* List past surgeries (Date, Type of Surgery, and Outcome/Long term effects):*Are you currently under a doctor's care for any condition?* Yes No If yes, please specify:*Are you taking any prescription medications?* Yes No If yes, please specify:*Do you have any physical handicaps?* Yes No If yes, please describe:*Do you have an eating disorder/history of an eating disorder?* Yes No If yes, please describe:*Do you have any special dietary considerations?* Yes No If yes, please describe:*Do you have medical insurance?* Yes No Name of Insurance Company:* Are you insured under a parent or guardian's plan?* Yes No Name of Emergency Contact:* Relation to Emergency Contact:* Phone Number of Emergency Contact:* Medical Release I agree to the medical release.The information I have provided is true and correct to the best of my knowledge. In the case that I or my emergency contact are not able to make medical decisions (after 100 Fold has made every effort to contact the emergency contact), permission is granted to a 100 Fold representative to make arrangements in securing proper treatment, including hospitalization, anesthesia, and other injections, x-rays, or any other operations that may be immediately be needed. Release Forms Please download, sign, and upload these release forms. Image Release Form Waiver of LiabilityImage Release Form*Max. file size: 8 MB.Waiver of Liability*Max. file size: 8 MB. General Info How are you planning to arrive to Summer Studio?* Driving Flying If you can bring a car out, that is highly encouraged as we are in a rural area of MontanaPlease upload your flight itinerary:Max. file size: 8 MB.If you don't have your flights yet, send them to once you have them summer@100foldstudio.orgPlease Upload Scan of Passport if InternationalMax. file size: 8 MB.Please Take the MBTI assesment and upload results:Max. file size: 8 MB.Upload results with each percentage. Test can be found at https://www.16personalities.com/Summer Studio PrepDuring the summer, we will have opportunities for 1-on-1 mentorship conversations with our staff. Would you rather have reoccurring meetings with one staff member through the summer or the option to sign up for individual conversations with multiple staff members? What is one thing you are excited about for this summer? What is one thing you are nervous about for this summer? What are your questions about God? Bible StudyThis summer we will be going through a bible overview curriculum. We believe that understanding the story of the bible is fundamental to our walk with Jesus and to understanding our own stories and those of the people around us. As we begin this journey together, we want to know what questions you have about God, the Bible, and yourself/humanity. What are your questions about yourself/humanity? What are your questions about the Bible? What is a fun fact about you? (for a game in orientation) Roomate preferencesYou'll be sharing a room with three or four students.Are you a night owl or an early bird?Early BirdNight OwlFlexibleHow tidy do you keep your space?Very neatModerately tidyA bit messy, but organized chaosVery neat Moderately tidy A bit messy, but organized chaosIf there is one word to describe your ideal roommate’s vibe, what would it be? Signature* I agree by signing electronically below that the information above is correct to the best of my knowledge and that I have fully read through the guidebook sent to me by 100 Fold Studio.Name* First Last Date* Month Day Year Any questions? Δ