Winter Camp 2025 Medical Form

Alternate Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts as we will alway seek to contact you first. List the name of another person who can be contacted in the event of an emergency or illness and you cannot be reached. Any person listed should be over 18, able to assist in contacting you, and be authorized to pick the child up from camp.
Full Name*

First NameLast Name
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Relationship to Child*

Basic Health Info
Allergies? Check all that apply*

FoodMedicationEnvironmentalNone
Please list and explain any allergies

PLEASE PROVIDE TYPCAL REACTION TO ALLERGEN0/150
Do you have any current health conditions that would be helpful to know about in case of an emergency? (i.e. diabetes, epilepsy, pregnancy, etc.)
Emergency Contact
Emergency Contact Name:*

First NameLast Name
Emergency contact phone number*

Area CodePhone Number
Your emergency contact's relationship to you?*

Purchasing a Gift Card for your Camper

This Winter we will be using an electronic gift card system for our Camp Store.
We are no longer using physical gift cards, but you can check out how our new e-gift card system works and purchase a gift card for your camper by clicking this link: pondo.org/gift-card/. A page with this link will also pop up after you have submitted this form.
Signature
Sign Document*
If you would like to print the form for your records, please do so before submitting.
Should be Empty:

Basic Health Info