Camp Health and Medical Consent for Minor
Camper Information
Camper Full Name
Date of Birth
Home Address
Parent/Guardian Name
Contact Phone Number
Emergency Contact Name
Emergency Contact Phone
Health Information
Allergies (food, medication, etc.)
Medical Conditions
Medications (name, dosage, frequency)
Date of Last Tetanus Shot
Health Insurance Provider
Policy Number
Consent and Authorization
I, the undersigned parent or legal guardian, authorize the camp staff to provide necessary medical treatment for my child in case of emergency.
Parent/Guardian Signature
Date