All areas of this form must be completed and signed prior to camp participation.
Guardian’s Name
Your answer
Relationship:
Your answer
Allergic reactions (drugs, food, asthma, etc.)
If Yes, list
Your answer
Taking medication at this time?
If Yes, list
Your answer
In Case of Emergency
Father-Work and or Cell:
Your answer
Mother-Work and or Cell:
Your answer
Other Emergency Contact:
Your answer
Other Emergency Contact Phone Number:
Your answer
Your Insurance Company____________________________include company & policy number; be prepared to bring a copy of the card in with you on the first day of camp