Camp Medical Forms

We understand there is duplicate information you are providing but this form is what we use in the event of an emergency with your camper.

Child Care Information

Camper's First Name

Camper's Last Name

Camper's Nickname

Camper's Birthdate

Camper's Age

Parent (s) and Other Contacts

First Name

Last Name

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Phone Number

Mobile Phone Number

Emergency Contact Information

First Name

Last Name

Phone Number

Relation to Camper

Medical/Health/Insurance Care Information

Doctor's Name

Phone Number

After Hours Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Health Insurance Company

Group/Policy #

Insurance Phone Number

Special Needs

Explanation/Treatment above:

Does your child need to take medication while at camp?

Yes

No

If Needed

Immunization - Date of last Tetanus:

Special Instructions/Comments

Medication Dispensing Information, Permission, and Waiver

Only fill out this form if your child takes medication on a daily basis.

Camper's First Name

Camper's Last Name

Age

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Doctor's Name

Phone Number

Medication Information

Medication #1

Dose

Time Dispensed

Dispensing Instructions

Possible Side Effects

Medication #2

Dose

Time Dispensed

Dispensing Instructions

Possible Side Effects

Signature

Today's Date