Camper Medical Information Form
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What week did your camper register for?
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Camper's Last Name *
Camper's First Name *
Parent's Last Name *
Parent's First Name *
Camper's MCP Number *
When did your child receive their most recent immunizations? *
Required
Does the camper have any of the following allergies? *
Required
If you have identified Food, Medication, or Other allergies, please specify what your child is allergic to:
Does your child have any of the following?
Does your child have any of the following? *
Required
If you checked any of the above, please specify:
Does your child have any other medical considerations we should know about? Please elaborate.
NOTE: All over-the-counter drugs and prescription drugs must be brought along and passed in at registration in the original containers with the name of the camper, medication, and dosage information clearly visible. Asthmatics must bring puffer to camp. *
Required
Please list any medications your child takes, and specify when the medication should be administered.
Please Read Carefully: To the best of my knowledge, my child is in good health and able to participate in all camp activities. I will notify the camp if my child is exposed to an infectious disease during the week prior to arriving at camp. *
Required
Please Read Carefully: As the parent/guardian of this camper, I hereby authorize the Camp Director and/or Health Care Provider to secure such medical, surgical, legal, or other advice and services as may be deemed necessary for the health and safety of my child. Parents will be billed for emergency transportation and any other medical costs incurred for this camp. It shall be at the discretion of the Camp Director and Health Care Provider as to what steps must be taken for the welfare and safety of the camper. *
Required
Please Read Carefully: I hereby authorize the camp's Health Care Provider to administer the following: (check all that apply) *
Required
Every care and attention will be given to the health and safety of of the campers, but the Camp Director and his/her staff cannot be held responsible for any accident that may occur. *
Required
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