Spartanburg School District Six: Summer Camp Medical Forms

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Please fill this out before you attend any of the Dorman summer camps.

***You only need to fill this for out once, even if you are going to multiple camps.***

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Camper's Last Name *

Camper's First Name *

Date of Birth *

JJJJ

Age *

Parent/Guardian Name (1)

Parent/Guardian Phone Number (1)

Parent/Guardian Name (2)

Parent/Guardian Phone Number (2)

Emergency Contact Name (1) *

Emergency Contact Phone Number (1) *

Emergency Contact Name (2) *

Emergency Contact Phone Number (2) *

Please list any medical conditions your child has

Please list all allergies your child has (insects, food, medication, contact allergies)

Please list any reactions and treatments we may need in order to help with any allergic reactions

Are there any emergency medications your child will need access to while at camp? (EpiPen, Glucagon, Asthma Inhaler)

Yes

Auswahl löschen

If yes, please list name of medicine and dosage.

In case of a medical emergency, I hereby give permission to the District Six representative to secure proper treatment for my child. I further give permission to the physician/hospital to hospitalize, order injections, anesthesia, or surgery for my child if deemed necessary. *

I agree

I disagree

Parent/Guardian Signature (type in name) *

Senden

Alle Eingaben löschen

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Dieses Formular wurde bei Spartanburg County School District 6 erstellt. Missbrauch melden

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