Camper's Full Name

Parent/Guardian Name(s) Emergency Contact Number Alternative Emergency Contact Name & Number

Health Insurance Provider Policy Number Physician Name & Phone Number

List any allergies (food, medications, etc.) Medical Conditions (asthma, diabetes, etc.) Medications Taken

Authorization for Medical Treatment:
I hereby authorize the camp medical staff to administer first aid, prescribe treatment for, or hospitalize my child if necessary. I agree

Release and Waiver:
By signing below, I release the camp, its staff, and affiliates from liability in the event of injury or accident.