• Camper Application

    Camp by Activate Church Huntington Beach
  • Camp Information

    Camp Dates: July 4-8
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  • Campers Emotional / Behavioral History

  • Health History

    Indicate all known allergies, illness, disabilities, physical limitations or medical complications:
  • IMMUNIZATION HISTORY

    Please fill in dates of basic immunizations and most recent booster as best as you can.
  • PRESCRIPTION MEDICATION

    ALL MEDICATION SENT TO CAMP MUST BE IN ORIGINAL CONTAINER WITH THE PHARMACY LABEL ON IT.
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  • AUTHORIZATIONS

    I understand that it is my responsibility as caregiver to make sure that all instructions are clear and that necessary dosage is adequately supplied for the duration of damp. I hereby authorize RFKC’s nurse to administer the above medication from June 15, 2020 to June 19, 2020.
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