2026 Summer Camp Medical Form
Fill out your child's medical information carefully! One submission per camper required!
Name of Person Completing This Form:
*
First Name
Last Name
Relationship to Camper
*
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Camper's Name
*
CAMPER First Name
CAMPER Last Name
Camper's Age
*
Select your camper's Age Division
*
Rookies (Ages 4-6)
Allstars (Ages 7-8)
Legends (Ages 9+)
Select ALL weeks that your child will be attending
*
Gap Camp (May 25-29)
Week 1 (June 1-5)
Week 2 (June 8-12)
Week 3 (June 15-19)
Week 4 (June 22-26)
Week 5 (June 29 - July 3)
Week 6 (July 6-10)
Week 7 (July 13-17)
Week 8 (July 20-24)
Week 9 (July 27-31)
Week 10 (Aug 3-7)
Gap Camp (Aug 10-14)
Emergency Contact #1
Name
*
First Name
Last Name
Relation to Camper
*
Father, Mother, etc.
Phone Number #1
*
Format: (000) 000-0000.
Phone Number #2
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact #2
Name
*
First Name
Last Name
Relation to Camper
*
Father, Mother, etc.
Phone Number #1
*
Format: (000) 000-0000.
Phone Number #2
Format: (000) 000-0000.
Email
*
example@example.com
General Medical History
Is the Camper up-to-date all necessary immunizations?
*
Yes
No
Does your child have any allergies (food, medicine, environmental)?:
*
Yes
No
Allergy Risk/Level of Concern
*
Low
Medium
Severe
Not applicable
Please list and describe any allergies:
In the event of an allergic reaction, please provide an action plan for us to follow (list steps in order):
I.e. 1. Call Home/911 2. Administer medication 3.etc.
Any significant Medical History (surgery, injuries, serious illness etc.):
List and briefly describe any Medical Conditions (asthma, seizures, headaches etc.). Type N/A if not applicable.
*
Medical Condition Level of Concern
*
Low
Medium
Severe
Not applicable
Please provide a Medical Condition Action Plan (list steps in order):
Prescribed medications taken by the Camper (Please list the name, and frequency taken)
Does your camper need to have medication(s) to be kept on campgrounds? Hi-Five Staff members can hold necessary medical supplies on camp grounds if necessary.
Yes
No
List any medications that would need to be kept on campgrounds.
Does your camper require regularly scheduled medication during camp hours?
Yes
No
Does your camper require a member of our staff to assist with administering medications?
Yes
No
If yes, please list & provide detailed instructions (Medication, frequency, time, etc.):
If my child requires assistance, I consent to Hi-Five staff administering my camper's medication listed above.
In the event that the camp is leaving campgrounds (field trips), are there medications or supplies that must be taken with this child
Yes
No
I consent to the following administration: spray sunscreen, exact dosage: liberal application per exposed area, to be administered: before high sun exposure.
*
Signature
Emergency Medical Authorization. I, the parent/legal guardian of the participant listed on this registration, authorize Hi-Five Sports Club staff, coaches, employees, and representatives to provide or obtain emergency medical care for my child if I cannot be reached immediately in the event of an illness, injury, or medical emergency occurring during camp or program activities.By signing below, I authorize:Basic first aid treatment administered by camp staffContacting and utilizing Emergency Medical Services (EMS), including ambulance transportation if deemed necessaryEmergency evaluation, treatment, hospitalization, anesthesia, surgery, or other medical care recommended by licensed medical professionalsI understand that every reasonable effort will be made to contact me or my designated emergency contact prior to medical treatment whenever possible.I acknowledge that I am financially responsible for any medical expenses incurred as a result of emergency treatment or transportation.I certify that the health information provided for my child is accurate and complete to the best of my knowledge.
Emergency Medical Authorization... I, the parent/legal guardian of the participant listed on this registration, authorize Hi-Five Sports Club staff, coaches, employees, and representatives to provide or obtain emergency medical care for my child if I cannot be reached immediately in the event of an illness, injury, or medical emergency occurring during camp or all other program activities. By signing below, I authorize: Assisted application of spray sunscreen, Basic first aid treatment administered by camp staff, Contacting and utilizing Emergency Medical Services (EMS), including ambulance transportation if deemed necessary, emergency evaluation, treatment, hospitalization, anesthesia, surgery, or other medical care recommended by licensed medical professionals. I understand that every reasonable effort will be made to contact me or my designated emergency contact prior to medical treatment whenever possible. I acknowledge that I am financially responsible for any medical expenses incurred as a result of emergency treatment or transportation. I certify that the health information provided for my child is accurate and complete to the best of my knowledge.
*
Printed First, Last Name
*
Medical Insurance Details
Name of Insurance Company:
*
Policy Number:
*
Group Number:
*
INSURANCE CARD
*
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