Health Career Discovery June 2026
Attend both classes on June 16 and 17, 10a-2pm - The Health Career Discovery Program gives middle and high school students the opportunity to learn more about the different areas of healthcare and how to prepare for a future in the healthcare field. Details with an agenda will be provided closer to program start. Additional paperwork may be required and will be emailed to you after registration if needed. Questions? Contact Lydia Benter at 812-522-0551 or lbenter@schneckmed.org. Thank you!
Participant Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School you attend?
*
Age?
*
How did you learn about the program?
*
Newspaper ad
Schneck Facebook/Instagram
School
Career Fair
Jackson County Workforce Development
Schneck Website
Other
If you chose "other" above, please tell us how you learned about the program.
Choose your two top areas of interest for the program:
*
Surgery
Nursing
Emergency Services
Respiratory Therapy
OBGYN
Dietetics
Diagnostic Imaging
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any allergies or health conditions?
*
YES
NO
If yes, please list here:
*
Family physician:
*
Family physician phone number:
*
Please read item and check the box:
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I will comply with the Tobacco Free Policy at Schneck Medical Center.
I agree to observe and not participate in any tasks, care or treatment to a patient.
I will be accompanied by an assigned staff member, except in public areas.
I grant permission that my photo may be taken and appear in marketing materials for future programs.
I understand and agree to keep confidential anything I see, hear or learn about patients or customers of Schneck Medical Center during the program. I understand the Hospital is not responsible for any accidents or lost articles during the program.
Electronic signatures
I understand that my electronic signature is the equivalent of my handwritten signature and I am legally bound to this agreement.
Participant Signature
*
If you are under the age of 18, you must have parental consent to participate. Parent please sign below.
Continue
Continue
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