CREATE No School Day Camp Health & Pickup Authorization Form (2022-23)
PLEASE COMPLETE AND SUBMIT THIS FORM AT LEAST 24 HOURS BEFORE THE START OF THE CAMP DAY.

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.
อีเมล *
Last Name of Child *
First Name of Child *
Date of Birth *
วว
/
ดด
/
ปปปป
Gender *
Preferred Pronouns (optional)
Dates of No School Day Camp Session/s *
Name of Parent/Guardian Completing and Submitting Form *
Allergies *
Please check boxes for any known allergies
จำเป็น
If your child has an allergy listed above, please describe the allergy, typical reactions seen, and medications taken.
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 at the front desk with the CREATE staff member.
If you answered "YES" to the previous question, please provide the name of medication(s), dosage, and instructions.
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!
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