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Camp Medical Information Form.pdf

75693a_6afddca55ee14041ba551fa4b651b405.pdf

Preview of Camp Medical Information Form

🔗 Source: westsideministriesturlock.com

📊 Size: 55 KB

📄 Pages: 2 pages

⬇️ Downloads: 39

Summary

- Name: [Not specified]
- Age: [Not specified]
- Date of Birth: [Not specified]
- Grade (Fall '22): [Not specified]
- Address: [Not provided]
- City: [Not specified]
- State & ZIP: [Not specified]
- Contact Numbers: Home: [Not specified], Cell: [Not specified], Email: [Not specified]
- Emergency Contact: [Not specified]
- Relationship to Emergency Contact: [Not specified]
- Family Doctor: [Not specified]
- Phone (Doctor): [Not specified]
- Gender: [Male/Female, not stated]

Health History:
- No specific health conditions or allergies listed.

Medications:
- None mentioned.

COVID Vaccine:
- Yes (optional field, but no explicit 'No' option provided)

Swimming & Activity Restrictions:
- Yes for swimming restrictions (no details given), and Yes for activity restrictions (details not provided).

Medical Information for Camp:
- To be sent if required for injuries or illnesses during camp.

Insurance:
- Health Insurance: Yes
- Company: [Not specified]
- Policy Number: [Not specified]

Medical Release & Waiver:
- Signed by parent/guardian, granting permission for medical treatment and hospitalization if necessary.
- Both sides of the release form must be filled out and signed.

Participation Agreement (Camp 356):
- Includes a waiver and indemnity agreement for various activities, acknowledging potential risks.
- Signatures required from parents/guardians for children under 18 participating in Camp 356 activities.

Download File

Description

**AGE:** [Age]
**DATE OF BIRTH:** [Date]
**GRADE:** [Grade]
**ADDRESS:** [Address]
**CITY:** [City], **STATE:** [State], **ZIP:** [Zip]
**CONTACTS:** Home: (...); Cell: (...)
**EMAIL:** [Email]
**EMERGENCY CONTACT:** [Name], (...)
**GENDER:** Male
**HEALTH:** No known allergies or conditions.
**FAMILY DOCTOR:** [Doctor Name and Phone]

Technical Information

File Format: PDF
File Size: 55 KB
Pages: 2
Language: EN
Total Downloads: 39
Last Updated: 1 week ago

Document Overview

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