VHCP Summer Camp Medical and Emergency Forms
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Email *
Child Medical Information
Please list information for all of your children attending summer camp this year, including older siblings coming on your workday.
Child's full name *
Date of birth *
MM
/
DD
/
YYYY
Allergies/Drug Reactions/Medications/Other Information
 *
Child #2 - Child's full name
Child #2 - Date of birth
MM
/
DD
/
YYYY
Child #2 - Allergies/Drug Reactions/Medications/Other Information
Child #3 - Child's full name
Child #3 - Date of birth
MM
/
DD
/
YYYY
Child #3 - Allergies/Drug Reactions/Medications/Other Information
Child #4 - Child's full name
Child #4 - Date of birth
MM
/
DD
/
YYYY
Child #4 - Allergies/Drug Reactions/Medications/Other Information
Child Doctor and Insurance Information
Children's doctor/hospital *
Doctor's phone number *
Children's Insurance company *
Policy number *
Group number *
Child Emergency Contacts
Parent/Guardian #1 - Full Name *
Parent/Guardian #1 - Address *
Parent/Guardian #1 - Phone number *
Parent/Guardian #2 - Full Name
 *
Parent/Guardian #2 - Address
 *
Parent/Guardian #2 - Phone number
 *
Please list one additional person to notify in case of emergency - Full name *
Please list one additional person to notify in case of emergency - Relationship to child(ren) *
Please list one additional person to notify in case of emergency - Phone number *
Non-Washington State Emergency Contact - Full name *
Non-Washington State Emergency Contact - Relationship to child(ren) *
Non-Washington State Emergency Contact - Phone number *
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