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 HiddenTB Test*Max. file size: 8 MB.A TB test is required for living in the YWAM dorms. Please upload proof of a negative test result within a year of Summer Studio's start date. If you have been immunized against TB (common in some countries other than the US), you can upload a blank document as long as it is on your immunization record.Immunization Record*Max. file size: 8 MB.Please include covid vaccinations if you have received them.HiddenHave you tested positive for COVID-19?* Yes No HiddenIf yes, please list the most recent date of a positive test:*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. Miscellaneous Info HiddenHow 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.Please upload your travel insurance policy:*Max. file size: 8 MB.We are requiring that every person purchases travel insurance that covers medical expenses including potential medical evacuation. This is a precautionary measure, but better safe than sorry 🙂Please Upload Scan of Passport*Max. file size: 8 MB.Please Take the MBTI assesment and upload results:Max. file size: 8 MB.Refer to email about this form for example of what the results should look like. Test can be found at https://www.16personalities.com/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