2025 Camp Tamarack Physical/Immunization Form

2025 Camp Tamarack Physical/Immunization Form- Due July 1st

(All information on this form is confidential)
Camper Last Name*
Camper First Name*
Birth Date*

MonthDayYear
Current Age*
Gender*

MaleFemaleNon-Binary/Other
Date of most recent physical (must be within 24 months)*

MonthDayYear
Date
Clinic Name:*
Clinic Phone Number:*
Clinic Address:*
Insurance information:

Camp Tamarack only carries secondary health insurance. Please provide your child's primary insurance information.
Insurance Company:*
Insurance Company Phone Number:*
Insurance Policy # *
Optional: Upload insurance card (Front and Back)

Cancelof
Immunizations Dates (or attach a form from your clinic)

Must attach form or fill in dates or child is not eligible for camp- Routine childhood vaccinations are required to attend Camp Tamarack
DTaP or DT (Tetanus)

MonthDayYear
Date
MMR (Measles, Mumps, Rubella)

MonthDayYear
Date
Polio

MonthDayYear
Date
Hepatitis B

MonthDayYear
Date
Upload immunzation form or fill in immunzation dates above

Cancelof
Medications: If yes, explain or type none*
Allergies: drugs, food, other (provide details) or type none*
Health Questionnaire
Choose one*

Child is in good health and able to participate in all camp activitiesChild has a condition that may limit participation. If yes, explain below
Explain condition that may limit participation in activities:
Does your child have any conditions that you would like to inform your child's counselor and the staff directors about? Examples - Nightmares, Sleep Walking, ect.
By signing this form, you agree to the following: (1) the above named child has your permission to attend Camp Tamarack of MN; (2) Camp Tamarack staff has permission to transport your child to and from camp by bus to Annandale, MN; (3) Camp Tamarack staff has permission to seek and initiate emergency medical and surgical treatment for the above named child if needed; (4) Camp Tamarack staff has my permission to provide routine, non-surgical medical care to the above named child.

Camp Tamarack uses an app called PhotoCircle to share photos of campers and staff during the week at camp. If you don't want you child's picture to be shared in this private password required app, please send me an e-mail. Davi: tamarackcampmn@gmail.com
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Should be Empty:

2025 Camp Tamarack Physical/Immunization Form- Due July 1st

Insurance information:

Immunizations Dates (or attach a form from your clinic)

Health Questionnaire