• Camper medical information and medical emergency contacts.

  • Please complete this form for each of your SummerSault campers. We will keep this information on file for the duration of camp. 

    Need help or have questions about the form? Email us any time at summersault@townschool.org.

  • Family Address and Contact Information

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  • Parent/Guardian 1 Contact Information


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  • Parent/Guardian 2 Contact Information


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  • Emergency Information

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  • Medical Emergency Contacts

    If neither parent can be reached, please list at least one alternate contact who can help direct your child’s medical care.
  • In a medical emergency, if neither parent can be reached, please contact the following person(s):

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  • Health History and Current Conditions

  • Current conditions or illnesses

  • History of diseases

  • Current Allergies

  • Health Events History

  • Permission for camper to have Tylenol

    Tylenol will be administered by the camp nurse.
  • Consent to Share Important Information with Camp Staff

    The electronic signature below and its related fields are treated by SummerSault like a physical handwritten signature on a paper form.
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    Pick a Date
  • Consent to Treat Digital Signature

    The electronic signature below and its related fields are treated by SummerSault like a physical handwritten signature on a paper form.
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    Pick a Date
  • Other Information

  • Should be Empty: