MIT Campus Preview Weekend 2013: Medical Release Form
THIS FORM MUST BE COMPLETED AND RETURNED BY MARCH 28, 2013
All students attending Campus Preview Weekend must complete and return this form via fax.
Please fax your completed form to 617-687-9184 no later than March 28, 2013.
*Parents must complete this form for students under the age of 18.*
Cell Phone: __________________________
Birth Date: _____________________
Evening Phone: ___________________________
Name and phone of person with whom student resides:______________________________________________
(if different fro