Health Form

Student Health Documents 2021/22

* Indicates required field

Student Name *

First

Last

Proof of Health Coverage

Every student is required to upload proof of health coverage for both Canada and the US before attending.

Ontario students are covered with OHIP Health Cards. All must provide proof of health insurance for emergency services in the USA.

Internationals can either produce coverage from a parent's employment plan, or purchase insurance through Guard.me Insurance plan. A21 Academy can assist in setting up Guard.me international health insurance as indicated in form below.

Please choose coverage and upload proof here:

Choose Health Coverage *

Upload Proof of Coverage CAN other than Guard.me *

Max file size: 20MB

UPLOAD PROOF OF COVERAGE USA other than Guard.me *

Max file size: 20MB

Upload STUDENT IMMUNIZATION RECORD or statement of relief *

Max file size: 20MB

Click HERE to complete
and upload (to left)
STATEMENT OF RELIEF FORM
rather than Immunization.

Authorization to assist and transport your child in event of medical concern

I/we understand and acknowledge that the staff, officers, employees and agents of A21 Academy act in the place and position of guardian of my child(ren) while in attendance at A21 Academy. Recognizing this, I/we authorize each or any of them to provide to my child(ren) any medical treatment and support that they consider to be reasonable or necessary.

In consideration of their willingness to care for my child(ren), I/we release, remise and discharge, indemnify and save harmless, the A21 Academy Ltd, its Board of Directors, officers, employees and agents from any and all liability, claims or causes of action by virtue of application, or non-application of medical treatment and not liable for any accident or loss however caused. I/we agree to release A21 Academy from all claims and damages

Authorization is given to A21 Academy to assist and transport *

I authorize A21 Academy

Submit