EMERGENCY CONTACT INFORMATION
HEALTH INFORMATION
Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?
YES
NO
Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child's camp experience is posible?
IMMUNZATION INFORMATION
Must list current residence above.
For camperswho currently reside within the United State Territory, or the District of Columbia: Does the camper have any immunzation exemptions because of a parental or guardian objection or medical contraindication?
For campers who reside outside the Unites States, a Unitd States territory, or the District of Columbia: Attach record of vaccination or medical contraindication?
Health Questionnaire
Please check YES or NO to the following questions below to determine if you need to fill in additional Health Forms. The additional Heath Forms must be downloaded as they require a prescriber’s/Doctor’s Signature. You may then upload them back to our website. Please click on the appropriate link to each question to access the corresponding Health Form. You may also access these forms on our home page on the FORMS Tab.
1. Does your child take any Medications?
YES (Please fill in FORM A)*
2. Does your child have any Allergies?
YES (Please fill in FORM B)*
3. Does your child have Asthma?
YES (Please fill in FORM C)*
4. Does your child have any Seizures/Convulsions or Epilepsy?
YES (Please fill in FORM D)*
5. Does your child require any Individualize Treatment/Care Plan?
YES (Please fill in FORM E)*
