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Home/ Fir Acres Writing Workshop/ Written Medical Documentation: Additional Participant Information 2024

Written Medical Documentation: Additional Participant Information 2024

Written Medical Documentation

We ask that you attach written medical documentation for any participant who has chronic or serious health or mental health and/or accessibility requirements. Please attach further written documentation from the participant’s physician or medical health professional detailing the plan for the ongoing care of these conditions. Please complete this form no later than May 1st.

We thank you for helping us plan your Workshop by filling out this important form. The more information we know about you before you arrive, the better your experience will be once you arrive in Portland.

If you have questions or concerns, please email (firacres@lclark.edu) or call us at 503-768-7932 and we will do our best to answer your questions.

Please upload written medical documentation as a PDF.

All fields marked with asterisk (*) are required.

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PARTICIPANT

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Does Participant have chronic health or mental health and/or accessibility requirements?
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Please attach a statement from the Participant’s physician or medical health professional which: (1) describes the condition and the plan to manage it, including medications while at the Workshop; (2) lists behaviors that will indicate to our staff that the Participant needs professional referral; and (3) states that the medical professional foresees no difficulties in your child’s full participation in the Workshop.

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Participant has been diagnosed with:
Please select all that apply. Press “command” to select more than one.
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Please attach a statement from the Participant’s physician or mental health professional which: (1) describes the condition and the plan to manage it, including medications while at the Workshop; (2) lists behaviors that will indicate to our staff that the Participant needs professional referral; and (3) states that the medical or mental health professional foresees no difficulties in your child’s full participation in the Workshop.

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PARENT / GUARDIAN COMPLETING THIS FORM

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Please attach additional written medical documentation about your participant’s health or mental health concerns below . If we feel we need more information from you or from your participant’s physician, we will let you know. Please upload in PDF file format.

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(50 MB max)

email 

voice 503-768-7932 

Director Don Waters

Administrative Coordinator Amy Baskin

  • Fir Acres Writing Workshop
    Lewis & Clark
    615 S. Palatine Hill Road MSC 58
    Portland OR 97219