Okoboji Sports Camp Medical Form
Name:
*
Address:
*
Parent's Name:
*
Home Phone:
*
Cell Phone:
*
Father's Work Phone:
*
Mother's Work Phone:
*
Insurance Company:
*
Policy #:
*
Doctor's Name:
*
Doctor's Number:
*
Allergies:
*
Current Medications Taken:
*
Medical Problems (No matter how small):
*
Date of Last Tetnus Shot:
*
As the parent of the camper above, I hereby give Mrs. Deutsch, or Mrs. Matthew permission to take my child for treatment if necessary upon injury or sickness while my child is in their care.
*
Yes, I do give permission for the Okoboji Staff to take my child for treatment if necessary.
No, I do not give permission for my the Okoboji Staff to take my child for treatment if necessary.
Submit
Should be Empty: