Medical Treatment Authorization for Minors

As part of the administration of your program, you should require a "Medical Treatment Authorization for Minor" form for participants in your program.

This form should be readily accessible in the event medical treatment is necessary.  If a program participant requires medical services, CALL 911 for emergency medical services. However, if an ambulance is not required, Purdue Student Health Services (PUSH)  has board-certified physicians and nurse practitioners on staff to provide care Monday-Friday: 8:00am-5:00pm. PUSH is located at 601 Stadium Mall Drive, West Lafayette, IN 47907. For more information, visit their website  or call (765) 494-1700.

The medical director of PUSH has asked that you be certain to bring the "Medical Treatment Authorization for Minor" form along any time treatment is sought for a program participant at PUSH. If you have a medical history form for the child, please bring that as well.

Please email questions to


Medical Treatment Authorization for Minor Form