Camp Participation Physical Examination Sheet
Camper Information
Name
Date of Birth
Gender
Parent/Guardian Name
Phone Number
Emergency Contact
Medical History
Allergies
Medications
Past Illnesses/Injuries
Other Relevant Medical Information
Physical Examination
Height
Weight
Blood Pressure
Pulse
Vision (L/R)
Hearing
Skin
Teeth
Heart
Lungs
Abdomen
Extremities
Other Findings
Physician's Clearance
This participant is able to engage in all camp activities, except (if any):
Examining Physician's Name
Signature
Date