Japan Tour Medical Information | Phoenix Children's Chorus

The information collected in this form will be used solely for chorister, chaperone and staff safety during Cadenza and Encore Japan Tour. The information is confidential and shared only with healthcare professionals on tour and relevant PCC staff members.

First Name *

Last Name *

Email Address *

Is this form for a chorister, chaperone, or staff member? *

- Select - Is this form for a chorister, chaperone, or staff member? *

Emergency Contact Name (first & last) *

Emergency Contact Phone Number *

Any food allergies? If so, what reaction?

Any medication allergies? If so, what reaction?

Any environmental allergies? If so, what reaction?

Any updated medical issues or diagnoses not listed in Choir Genius?

List and explain. Type NA if it does not apply

In case of sickness or accident, we give permission for medical attention and treatment as deemed needed by healthcare professionals be administered. *

Yes

If you selected 'No' above, please explain so we know best how to help in an emergency.

Check all that apply: The medical staff on duty has permission to administer the following to the above named chorister: *

Acetaminophen (Tylenol)

Ibuprofen (Advil)

Tums (Upset stomach)

Antibiotic Cream (Neosporin)

Benadryl (Allergy Med)

Meclizine (Anti-Nausea)

List all active prescriptions with medication name, dose, and frequency *

Do you need proper documentation for Japanese officials to bring in medication? *

Yes

If so, do you have that completely filled out and ready to go?

Yes

Acknowledgement: ANY rescue medication should always accompany the chorister for PCC travel. Rescue medication is life-saving medication such as Epi-pens, Auvi-Q, inhalers, diabetic or seizure medications.

Failure to show chaperone/staff that they have packed their rescue meds at the airport during check-in will result in the chorister not going on tour.

I understand and agree that all rescue meds prescribed will go on tour. *
Yes