U.
S.
NAVAL SEA CADET CORPS
U.
S.
NAVY LEAGUE CADET CORPS REPORT OF MEDICAL HISTORY
AUTHORIZATION, CONSENT AND RELEASE
FOR OFFICIAL USE ONLY
NOTICE
Upon enrollment, the information requested below is required to provide the medical examiner an...
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U.
S.
NAVAL SEA CADET CORPS
U.
S.
NAVY LEAGUE CADET CORPS REPORT OF MEDICAL HISTORY
AUTHORIZATION, CONSENT AND RELEASE
FOR OFFICIAL USE ONLY
NOTICE
Upon enrollment, the information requested below is required to provide the medical examiner an accurate history of illnesses and injuries that may
affect the applicant s ability to perform the strenuous physical exercise and exposure to living and working environments that are a part of the
NSCC/NLCC training program.
Also this information will be provided to medical examiners in case of injury or illness while participating in
NSCC/NLCC activities.
If taking medications at time of enrollment, list in Block 9.
THE INFORMATION YOU PROVIDE MUST BE ACCURATE AND COMPLETE.
You are encouraged to consult your private medical provider
regarding past illnesses.
Proof of immunization for polio, measles, mumps, rubella hepatitis B, pertussis and tetanus plus diphtheria and Menactra
vaccine for Meningitis must be attached.
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