Camp Medical Forms Please fill out this camp medical form in addition to the Registering for the weeks of camp your child(ren) will be attending. Please enable JavaScript in your browser to complete this form. - Step 1 of 2Camper's Name *What weeks of camp is your child attending? *June 13-17June 20 -24June 27 - July 1July 11- 15July 18 - 22July 25 - 29August 1 - 5August 8 - 12Address *City, State & Zip Code *Parent/Guardian Names *Cell Number *Home Number Work Number Emergency Contact & Phone Number *Relationship to Camper *Medical Insurance Company *Your personal medical policy is your primary coverage. All registered campers are covered by excess coverage accident insurance while at camp.Policy Holder *Policy #: *Group #: *Pediatrician's Name *Pediatrician's Phone Number *AllergiesCurrent MedicationsDo we have permission to give your child Children's Tylenol?YesNoAre there any special instructions or things we should be aware about your child? *Do we need to administer any medication to you child during camp hours? *YesNoIf yes, we will need you to fill out an additional form in the front office.Will someone other than the parents/guardian being picking up your child from camp? *YesNoIf yes, we will need you to fill out an additional form in the front office.NextSignatureClear SignatureCaptcha * = MessageSubmit