KFS Summer Camp Registration Form

D) Medical Information
Family Physician*

First NameLast Name
Address*

Street Address

CityProvince

Zip CodeCountry
Has your child been fully immunized?*
Name of Health Unit
Has your child been diagnosed with any disease? If so, please specify.
Has your child ever had any serious illness or accident? If so, please specify.
Has your child's vision been checked?
Are corrective lenses required?
Has your child's hearing been checked?
Please elaborate further on the above if necessary.
Does your child have Epilepsy ?*
Does your child have severe allergies/anaphylaxis? Let us know if your child requires an epi-pen.*
Does your child have Asthma ? If yes, please make sure they bring their inhaler.*
Is your child taking or receiving any medication?*
If Yes, please provide more details and discuss this with our director.
Does your child have any known emotional or behavioural problems?*
If Yes, Please state in brief what and discuss this with our director.
Does your child follow a specific diet?*
If Yes, Please state in brief what and discuss this with our director.

A) Student Information