Summer Camp Medical Form Please enable JavaScript in your browser to complete this form.Camper's Name *What weeks of camp is your child attending? *No School Day CampSpring Break CampAddress *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.NextCaptcha * = PhoneSubmit