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Discipleship Training School (DTS)
First Half (Lecture Phase)
Daily Schedule
DTS Electives
Second Half (Outreach Phase)
Gap Year
Testimonies
Secondary Schools
School Of Ministry Development (SOMD)
Bible School for the Nations (BSN)
School Of Worship (SOW)
Summer Mission Trips
Louisville
Mexico
Spring Break
About
Our Beliefs & Values
Campus
Our Staff
University of the Nations
Contact Us
Discipleship Training School (DTS)
First Half (Lecture Phase)
Daily Schedule
DTS Electives
Second Half (Outreach Phase)
Gap Year
Testimonies
Secondary Schools
School Of Ministry Development (SOMD)
Bible School for the Nations (BSN)
School Of Worship (SOW)
Summer Mission Trips
Louisville
Mexico
Spring Break
About
Our Beliefs & Values
Campus
Our Staff
University of the Nations
Contact Us
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HEALTH FORM
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First Name
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First
Last Name
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Last
Email
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Gender
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Date of Birth
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Month
Day
Year
Height
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Weight (please specify lbs or kg)
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Personal History: Please answer all questions.
Please answer all questions. Have you ever had the following conditions or procedures? Explain any “Yes” answers in the space provided.
Epilepsy
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No
Please Explain:
Fainting Spells
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No
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Mental Nervous Disorder
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No
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Asthma
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No
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A History of Eating Disorders
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No
Please share details and timeline:
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Intestinal or Stomach Troubles
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No
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Recurrent Diarrhea
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No
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Anemia
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No
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Central Nervous Disorder (i.e. Multiple Sclerosis)
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No
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Allergies
Food
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No
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Medications
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Please list and explain any other health issues, medical conditions, or physical disabilities
Are you currently under a doctor's care for any condition?
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Are you taking medication at this time?
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Do you have a history of psychiatric or mental health treatment of any kind?
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Have you ever been medicated for emotional or mental health reasons?
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If you answer yes to either of the above, please share details and timelines. Also, please include details on anything like self-harm, depression, anxiety or suicidal thoughts.
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If you answer yes to either of the above, please share details and timelines. Also, please include details on anything like self-harm, depression, anxiety or suicidal thoughts.
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Can you walk 3-4 miles per day?
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Health Insurance
Health Insurance Company Name
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Please type your full name to certify your agreement that the information provided is accurate and truthful
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Today's Date
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