Summer Camp 2025 Health & Safety Form

Summer Camp 2025 Health & Safety Form

This form is required for your child to attend camp. If you have more than one camper, please complete one form for each child.
This form does not register your child for camp.

Registration must be completed online at www.el-cerrito.org/onlinereg.

Please note that you are not able to save progress on this form (i.e. fill out some information today and come back tomorrow with the rest). Before beginning, please have the following available:
- A recent photo of your child that you can download from the device you are using (i.e. your desktop computer, smart phone, etc.)
- Health insurance information
Camper Information
Camper Name*

First NameLast Name
Camper's Preferred Name or Nickname
Camper Birthday - MM/DD/YYYY
Camper's Pronoun
Entering Grade in 2025-26*
Photo of your camper (please make sure the photo is a clear image of their face without glasses or hats)*

Cancelof
Emergency Contacts
Please make sure that at least one of the three below contacts are available during the hours your camper is with us. In case of an emergency we'll need someone to answer their cell phone.

Please note: If you need to update this information on your online account, please do so at www.el-cerrito.org/onlinereg or email recreation@ci.el-cerrito.ca.us. This form will be utilized by camp staff in emergency situations but will NOT update your online account.
Emergency Contact 1*

First NameLast Name
Cell Phone*
Emergency Contact 2*

First NameLast Name
Cell Phone*
Emergency Contact 3*

First NameLast Name
Cell Phone*
Medical / Health Information
Health Insurance Company (Type N/A or none if none) *
Health Insurance Policy Number (Type N/A or none if none)*
Does the camper have any Allergies (including food, nuts, insect stings, hay fever, penicillin or other drugs, etc.), Disease (Hepatitis, Measles, heart disease/defect, epilepsy, diabetes etc.), Other Conditions (nosebleeds, behavioral, asthma, skin problems etc.) that we need to be aware of? Please provide details if so, or type N/A if none.*
Is there any additional information about your camper that would be useful for staff to know?
Statement of Understanding
Entering your full name below is your digital signature that you have read and accept the materials*

First NameLast Name
Signature*

Clear
Date Signed*

MonthDayYear
Date
Email Address
example@example.com
Should be Empty:

Summer Camp 2025 Health & Safety Form

Emergency Contacts

Medical / Health Information

Statement of Understanding