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Maskwa Medical Form 2022
PLEASE DO NOT COMPLETE THIS FORM IF YOU ARE ANSWERING "No" TO EVERYTHING. WE ONLY NEED THIS *IF* THERE ARE MEDICAL / BEHAVIOURAL ISSUES TO NOTIFY US OF.
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* Indicates required question
Email
*
Your email
Participant Name:
*
Your answer
Choose which group your child is in this summer:
*
Adventure Day Camp Block A
Adventure Day Camp Block B
Adventure Day Camp Block C
Adventure Day Camp Block D
Adventure Day Camp (Multiple Blocks)
U10 Boys
U10 Girls
U12 Boys
U12 Girls
U14 Boys
U14 Girls
Required
1a. Does the participant have any food allergies?
*
Yes
No
1b. If yes, please list food allergies here (or write N/A):
*
Your answer
2a) Does the participant have any non-food allergies that would impact them at camp?
*
Yes
No
2b) If yes, please list non-food allergies here (or write N/A):
*
Your answer
3a) Does the participant need to carry medication on them at all times in the event of a life-threatening medical crisis?
*
Yes
No
3b) If yes, please list medication and any instructions we should know here (or write N/A):
*
Your answer
4) Does the participant have any behavioral issues we should be aware of? If yes, please list here (or write N/A):
*
Your answer
5) Does the participant have any other medical conditions or diagnoses we should be aware of (please include Attention Deficit if applicable)? Please list here (or write N/A):
*
Your answer
Parent Name:
*
Your answer
Phone# In Case of Emergency:
*
Your answer
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