Youth Health & Registration Form

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Youth Health & Registration Form - HEARTS

HEALTH EDUCATION AND RELATIONSHIP TRAINING SERVICES (HEARTS) CAMP

This form should be completed for each young person participating in HEARTS Camp. The gathered information is confidential and will be treated accordingly. It is requested in order to assist facilitators in providing the best possible experience for youth attending the camp. Please fill out details of medication fully (names of medication, dosages, inhalers etc.)

REFERRED BY: (NAME OF CHURCH OR AGENCY) *

PREFERRED Camp Date: *

PREFERRED Camp Location *

SECTIONS A, B, and C are about the young person. SECTION D is about the parent/guardian.

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