SOLAR Player Medical Information

Please note: the following information is for SOLAR staff in case of an emergency. SOLAR will keep this information in confidence for game officials only, and on a need-to-know basis. If you are uncomfortable writing this information but still feel it should be known, please speak with the appropriate member of the SOLAR staff. Name: Character's Name and Race: Address: Telephone; ( Birth date: Please give the name and numbers of two people to contact in case of an emergency: Any special instructions in seeking medical treatment: (such as restrictions due to personal preferences or religious reasons)

Name:____________________________________________________

Character's Name and Race:___________________________________

Address: __________________________________________________

_________________________________________________________

Telephone: ( ____________ )

Birth date: ___/___/_19___

Please give the name and numbers of two people to contact in case of an emergency:

1. Name:____________________ Phone Number: ( ____________ )
2. Name:____________________ Phone Number: ( ____________ )

Any special instructions in seeking medical treatment: (such as restrictions due to personal preferences or religious reasons)