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Attendee Name
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Your answer
Attendee Date of Birth
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MM
/
DD
/
YYYY
Emergency Contact (full name)
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Your answer
Cell Number (emergency contact)
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Your answer
Alternative contact name (full name)
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Alternative contact (phone number)
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Primary Care Physician
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Your answer
Do you have a preferred hospital that you wish to use in case of an emergency? If yes, write it here. If not, leave blank and we will utilize whichever emergency services at the time recommends:
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Does the camper have any medical needs that we need to know about?
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Yes
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