Camp Medical Form 2027
Camper Information
Camper Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade Entering September 2027
*
Please Select
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Grade
Father's Email
example@example.com
Mother's Email
example@example.com
Father's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Information
Does your child have allergies or a medical condition?
*
Please Select
Yes
No
Allergies or Medical conditions
*
Camper requires an Epipen
*
Please Select
Yes
No
Camper has Asthma
*
Please Select
Yes
No
Camper uses Inhaler
*
Please Select
Yes
No
List any daily medication we should know
*
List any other medical information we should know
*
Do you give consent to the nurse to give Tylenol/Advil/Benadryl/etc. to your son if the circumstances call for it?
*
Please Select
Yes
No
Emergency Contact Information
Name of Emergency Contact #1
*
First Name
Last Name
Number for Emergency Contact #1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Emergency Contact #2
*
First Name
Last Name
Number for Emergency Contact #2
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: