Health and Consent Form for Summer Camp

Health and Consent Form for Training
At Camp Ford, we are committed to providing a safe and rewarding experience for all campers. To ensure their well-being, we require important health information, which will remain confidential and not be shared with third parties.

Health & Participation Guidelines:
- Campers must disclose any medical conditions, allergies, or injuries that may affect participation.
- A physician’s clearance may be required for campers recovering from recent injuries or medical conditions.
Impotant Notes:
- All submitted information is protected under HIPAA privacy laws.
- This form is valid only for the specific camp session registered. A new form is required for each camp.
What Camp are you registering for?
Name of Trainee

First NameLast Name
Date of Birth

MonthDayYear
Gender
Age
Name of Parent/Guardian

First NameLast Name
Phone Number (Landline)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Mobile)
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
In Case of Emergency
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Trainee
Please let us know what type of relationship does this person have with the Camper.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Insurance
Is Camper covered by an Insurance Policy?
Policy Number
Insurance Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Doctor Information
Name of Family Physician

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical History
Camper is fit and healthy to participate in an active camp program
Has Camper been exposed to any communicable disease in the past 6 months?
If yes, please specify
Are all of Camper's vaccination/immunizations as required by the public school system is updated?
Any previous hospitalizations/surgeries:
Any limitations to any activity as advised by a physician (i.e. running, jumping, etc.):
Medication

Football Summer Camp Medical & Liability Release Form:

The information provided in this form is true and accurate to the best of my knowledge. In the event of a medical emergency where the designated emergency contact cannot be reached, I grant permission for the camp representative to arrange necessary medical treatment. This may include hospitalization, anesthesia, injections, X-rays, or any other immediate procedures required for my child’s care.

I authorize the release of medical records necessary for insurance purposes and understand that the information provided in this form may be copied as needed to ensure appropriate medical treatment for my child.

I acknowledge that the camp will make every effort to contact a parent or guardian in case of an emergency. However, I understand that if I do not have medical insurance, I will be responsible for all medical expenses incurred.

Liability Release:
In consideration of my child’s participation in the camp, I hereby release, waive, and discharge the camp, its affiliates, staff, and representatives from any claims related to personal injury, death, or property loss resulting from participation in camp activities. I acknowledge that football and related activities carry inherent risks despite safety precautions, and I accept these risks.

I agree to indemnify and hold harmless the camp, its officers, staff, and affiliates from any claims, damages, or liabilities arising from my child’s participation.

I have carefully read and fully understand this waiver and release. By signing this form, I voluntarily agree to its terms, releasing the camp from liability to the fullest extent allowed by law.
Signature of Parent
Name of Parent Signatory

First NameLast Name
Date Signed

MonthDayYear
Date
Should be Empty:

Health and Consent Form for Training