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Health form
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Camper Name
*
First
Last
Parent/guardian Name:
*
First
Last
Email
*
Birth Date (mm/dd/yyyy):
*
Does the camper have any allergies?
*
Yes
No
If yes please specify the allergies and treatment or precautions.
the the please
Does the camper have any chronic illnesses or medical conditions?
*
Yes
No
If yes please specify conditions and treatment or precautions.
Is the camper currently taking any medications?
*
Yes
No
If yes please specify the name, dosage and frequency.
Has the camper ever had a serious illness or injury?
*
Yes
No
If yes please provide details.
Does the camper have any dietary restrictions or special dietary needs?
*
Yes
No
If yes please provide details.
Is the camper currently under the care of a healthcare professional?
*
Yes
No
If yes please provide the name and contact information for the provider.
Please provide any additional information that might be relevant to the camper's health and well-being during camp, such as fears, anxieties, or any other special considerations.
By signing this form, I certify that the information provided is accurate and up to date. I understand that it is my responsibility to inform the camp staff of any changes in the camper's health or medical condition. Parent/Guardian Signature:
*
date signed (mm/dd/yyyy):
*
Submit