Camp Form

Chorister's Name *

Would you like to be a Chaperone? *

Yes

No

Maybe

Medication required at camp? (Please list)

May the following be administered if necessary? *

Yes

No

Tylenol

Advil (Ibuprofen)

Gravol

Benadryl

Medicated Throat Lozenges

Any medical problems? (include physical, emotional or social difficulties)

Does the chorister have any physical weakness or disabilities for which they are/or have been in the care of a doctor? (e.g. Asthma, seizures, allergies, etc.)?