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CREATE 2023 Summer Camp Health Form
Please complete the following form regarding your child's health history accurately and to the best of your knowledge. You will need to complete a separate form for each registered child. If you would like to discuss any health concerns, please contact us at 301-588-2787 or
registrar@createartscenter.org
.
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* Indicates required question
Email
*
Your email
Last Name of Child Attending Camp
*
Your answer
First Name of Child Attending Camp
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Non-binary
Prefer not to say
Other:
Camp Sessions
*
Please check ALL sessions for which your child is registered:
Session 1 (June 12-176 [includes full week AND individual day registrations])
Session 2 (June 19-23)
Session 3 (June 26-30)
Session 4 (July 3-7)
Session 5 (July 10-14)
Session 6 (July 17-21)
Session 7 (July 24-28)
Session 8 (July 31 - August 4)
Session 9 (August 7-11)
Session 10 (August 14-18)
Session 11 (August 21-25)
Option 12
Required
Name of Parent/Guardian Completing and Submitting Form
*
Your answer
Allergies
*
Please check boxes for any known allergies
No Known Allergies
Food Allergies
Medicine Allergies
Environmental Allergies (pollen, bee stings, etc)
Other Allergies
Required
If your child has an allergy listed above, please describe the allergy, typical reactions seen, and medications taken.
Your answer
Will your child require any medications while at camp?
*
All medications brought to camp must be clearly labeled with child's name and any instructions for use. Unless otherwise indicated, medications will remain in the office during the day.
Yes
No
If you answered "YES" to the previous question, please provide the name of medication(s), dosage, and instructions.
Your answer
Additional Information
Please share any learning differences, notes about your child’s behavior, strategies that work well inschool and at home, etc. This will help us to ensure that we can help your child have the best possible experience at CREATE!
Your answer
I understand that:
*
Please check each box below to indicate that you have read and understand the following.
If my child has cold/COVID symptoms or a temperature reading over 100.4°F they will not be permitted to attend camp for the week.
If my child displays any symptoms of illness during the camp day, I will be available (or a named parent/guardian) to pick my child up from camp within 1 hour of being called by a CREATE staff member.
Masks are currently optional at summer camp. CREATE strongly encourages all non-vaccinated campers to continue to wear masks, as well as any other campers who prefer to remain masked.
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