Medical Clearance Form for Sports Camp Attendees
Participant Information
Full Name
Date of Birth
Age
Address
Phone Number
Medical History
Please list any chronic illnesses, medical conditions, allergies, or previous injuries:
Current medications (if any):
Physical Examination
Height
Weight
Blood Pressure
Pulse
Physician Comments/Findings:
Clearance
Cleared for full participation in sports camp activities
Not cleared for participation
If restricted, please specify limitations:
Physician Information
Physician Name
Phone Number
License Number
Signatures
Physician Signature
Date
Parent/Guardian Signature (if under 18)
Date