• Friends Youth Camp Adult Health Form

  • Church Information

    Please provide the following information regarding the church your camper attends.
  • Adult Information

  • Male/Female*
  • Adult Medical Information

    Please complete all sections accurately.
  • Adult Birthday*
     - -
  • Are you covered by medical insurance?*
  • Food Allergies

    This section is for food allergies. Please list any applicable. Note: There is a later section for dietary restrictions, such as vegan/vegetarian.
  • Do you have food allergies?*
  • Do you have dietary restrictions? (Vegan, vegetarian, etc)*
  • Seasonal/Other Allergies

    Please list any allergies the Camp Nurse should be aware of.
  • Seasonal/Other Allergies?*
  • Medication Allergies

    Please list any known medication allergies and reactions.
  • Does your child have any medication allergies?*
  • Emergency Contact

  • Format: (000) 000-0000.
  • Consent to Treat/Medical Release

  • Today's date*
     - -
  • Photo/Media Release

  • I understand that I might be photographed and/or videoed while at Friends Youth Camp at Camp Muskingum in Carrollton, Ohio. I understand that photographs/videos may be taken by staff and consent to the use, without compensation, of these photographs/videos for communication purposes, such as communication with the churches, Friends Youth Camp website, Social media sites, and or other communications.

  • I understand.
  • Should be Empty: