Camp Health Form

Each year campers are required to fill out a current health form which will give camp staff much needed information in the event of a medical emergency. Filling this out now will save you time when you get to camp!

Name

First Name

Last Name

Phone

(###)

###

####

IN CASE OF EMERGENCY PLEASE CONTACT

Please enter the name, address, phone and relationship.

Medications you are taking at camp:

Do you have a Medic Alert neckless or bracelet?

YES

Do you have any illness we should know about?

Please provide your Dr name/address/phone#

Please 'sign your name' and date this form before sending it. To ensure privacy, health forms may be filled out at camp and submitted in a sealed envelope with your name and cabin number on the outside. Campers are insured in case of accident as long as they are on the grounds. The insurance does not cover you if you leave the grounds.

Signature: Date: