Annual Health Questionnaire

Please make sure you have the following information available before beginning to complete this form:

• Student ID Number 
• Health Insurance Information (if other then SLU Student Health Insurance)
• Health Insurance Company
• Insured
• Insured Date of Birth
• Group Number
• ID/Policy Number
• Verification Phone Number
• Parent/Guardian Emergency Contact Information (Including cell, work, and home phone)

Note: If you answer "Yes" to any of the medical questions you will need to have your doctor complete "Health Questionnaire Form II" before you will be allowed to participate in practice, tryouts, games, etc.