Required Skillz Check Summer Camp Health & Safety Forms

Required Skillz Check Summer Camp Health & Safety Forms

All Skillz Check campers are required to complete the following form to ensure a safe and healthy experience for our players and staff and to comply with local Board of Health regulations.
For additional details, please refer to the Skillz Check Day Camp Parent Handbook. If you experience any issues or have questions contact us at support@skillzcheck.com.
Camp Week Selection

Please select all the weeks your child plans to attend. By letting us know now we will have this information on file and won’t need to follow up for future weeks. Don’t worry ... you can always register for additional weeks later! This form only needs to be submitted once for the entire summer.
Which Weeks Will Your Camper Attend*

Day Camp Week 1: June 15-19 (Shore Country Day - outdoors)Day Camp Week 2: June 22-26 (Shore Country Day - outdoors)Masco June Skillz Camp: June 22-26Day Camp Week 3: June 29 - July 3 (Danvers Indoor Sports - indoors)Day Camp Week 4: July 6-10 (Danvers Indoor Sports - indoors)Day Camp Week 5: July 13-17 (Bishop Fenwick HS - outdoors)Day Camp Week 6: July 20-24 (Danvers Indoor Sports - indoors)Day Camp Week 7: July 27-31 (Bishop Fenwick HS - outdoors)Residential Camp: Week 1: August 2-6 (New Hampton School)Residential Camp: Week 2: August 9-13 (New Hampton School)Day Camp Week 8: August 10-14 (Shore Country Day - outdoors)High School Pre-Season Clinic: August 10-13Day Camp Week 9: August 17-21 (Danvers Indoor Sports - indoors)Masco August Skillz Camp: August 17-21North Reading Skillz Camp: August 24-28Day Camp Week 10: August 24-28 (Danvers Indoor Sports - indoors)
Camper Information
Camper Full Name*

First NameLast Name
Camper Date of Birth*

MonthDayYear
Date
Camper Gender*
Parent/Guardian Contact Information
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address*
example@example.com
Emergency Contact Information
Emergency Contact Name (other than parent/guardian)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant*
Authorized Pickup Persons
Name of Authorized Person*

First NameLast Name
Relationship to Camper*
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
How many additional authorized pickup persons would you like to add?*

0123
Name of Additional Authorized Person 1

First NameLast Name
Relationship to Camper for Additional Person 1
Contact Phone Number for Additional Person 1
Please enter a valid phone number.Format: (000) 000-0000.
Name of Additional Authorized Person 2

First NameLast Name
Relationship to Camper for Additional Person 2
Contact Phone Number for Additional Person 2
Please enter a valid phone number.Format: (000) 000-0000.
Name of Additional Authorized Person 3

First NameLast Name
Relationship to Camper for Additional Person 3
Contact Phone Number for Additional Person 3
Please enter a valid phone number.Format: (000) 000-0000.
Health Provider & Insurance Information
Camper Health Insurance Provider*
Policy/Group Number*
Primary Care Physician Name*

First NameLast Name
Primary Care Physician Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Camper Medical Information
Upload Camper's Updated Physical Form*

Please upload a physical form dated within the last 18 months.
Cancelof
Date when the physical was taken*

MonthDayYear
Date
Does your camper have any activity restrictions? Camp activities are similar to those described on the camp website.*

No restrictionsYes, there are restrictions (include details below)
Does the participant have any allergies?*

NoYes
If yes, please list all allergies and describe reactions.
If the camper is at risk of anaphylaxis please upload an emergency allergy plan.

Cancelof
Does the participant have any chronic medical conditions (e.g., asthma, diabetes, epilepsy)?*

NoYes
Please provide any additional information about the above which may be helpful to our staff.
Medication Information & Authorization

Complete this section if your child will be bringing any medications to camp, including prescription, over-the-counter, inhalers, EpiPens, or other emergency medications. All medications must be in original labeled containers and will be stored and administered only by the Skillz Check Health Care Supervisor according to Massachusetts Department of Public Health regulations.
Will your child be bringing any medication to camp?*

YesNo
List all medications with Medication Name(s), Reason for Medication, Dosage & Timing, and Is this an emergency medication? (Yes/No)
Emergency Medication Self-Carry
Emergency Medication (Inhalers / EpiPens)*

My child will carry and self-administer their emergency medicationMy child will not self-carry emergency medication
Parent/Guardian Authorization
Self-carry is permitted with written parent/guardian authorization and approval by the Health Care Supervisor.
Parent/Guardian Authorization

I understand all medications must be provided in the original labeled containerI give permission for the Skillz Check Health Care Supervisor to store and administer my child’s medication in accordance with Massachusetts Department of Public Health regulations.
Parent/Guardian Name, Signature, and Date
Note: Camp staff other than the Health Care Supervisor do not administer medications.
Snacks and Treats Information
All campers are required to bring their own snacks, lunch (full day campers), and drinks each day. Water refills will be available on site.

Important: Skillz Check camps are nut-free environments to ensure the safety of all participants. Please do not send any products containing peanuts or tree nuts.

Occasionally, staff may offer a camp treat such as a lollipop or ice pop. All treats provided by staff will be nut-free.
My camper is allowed to receive (if they choose) a camp-provided treat such as an ice pop or lollipop.*

Yes, my camper has permission - if they choose - to have a treat.No, my camper is allowed to have a treat.
Sunscreen Policy & Permission
Do you give permission for Skillz Check staff to assist your child with the application of sunscreen during camp hours as needed?*

Yes - I give permission for Skillz Check staff to assist my child if needed with the application of sunscreen to exposed areas only (arms, legs, face).No - My child will apply sunscreen independently.
Required Camp Waivers & Authorizations
I, the parent/legal guardian of the camper, confirm that all information is accurate, and I understand and agree to the health, safety, and program policies outlined above.*
Please confirm you’re not a robot so we know your camper is human too!*
Should be Empty:

Required Skillz Check Summer Camp Health & Safety Forms

Camp Week Selection

Camper Information

Parent/Guardian Contact Information

Emergency Contact Information

Authorized Pickup Persons

Health Provider & Insurance Information

Camper Medical Information

Medication Information & Authorization

Emergency Medication Self-Carry

Parent/Guardian Authorization

Snacks and Treats Information

Sunscreen Policy & Permission

Required Camp Waivers & Authorizations