2019 Summer Camp Medical Form

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Please fill out the following form with the most up to date information. If you have any questions or concerns, please contact Chelsea VanAssche at chelsea.vanassche@westerville.org or (614) 901-6500.

Camper First Name *

Camper Last Name *

Camper Date of Birth *

Camper Address *

Phone number (xxx-xxx-xxxx) *

Camp Name (check all that apply) *

Camp Peanut (ages 6-7)

Camp Coconut (ages 8-9)

Camp Walnut (ages 10-12)

Heritage Kids Camp (ages 6-12)

Hoff Kids Fun Club

Metzger Kids Fun Club

Spring Grove Kids Fun Club

Millstone Kids Fun Club

Travel Camp

Outdoor Explorers Camp

Staycation Camp

Code Monsters Camp

Extreme Teen Camp

Outdoor Skills Camp

COSI Camp

Adventure Outdoors Camp

Sports Camp

Jr Engineering

Science Explorers

Required

Accommodations or Additional Camper Information

Note: Camp staff may request additional information on anything listed below in order to better serve your camper and your family. If anything changes throughout the summer, please feel free to reach out to camp staff.

Are there any accommodations that are needed for your camper to be successful at camp? If yes, please explain in detail. *

Is there any additional information that would be helpful for camp staff to know about the camper? If yes, please explain. *

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