Forms & Downloads

 
 

Health Forms

Upon confirmed enrollment in March, please download the following three pages to print off and fill out to complete the enrollment process. Please do not submit these until you have been granted a space in our program.

When filling out the Authorization for Emergency Medical Care, please complete the underlined blanks as follows:

I hereby authorize Molly Fisher and/or HCA Staff
AND
your child's name
AND
September 2018 (or when enrollment begins) and
for duration of enrollment.

Please attach a copy of your insurance card to this page and mail them to us at:

HCA c/o OPAG
7700 W. 75th
Overland Park, KS 66204
Attn: HCA health forms