summer camp medical & emergency contact form

Please fill out your camper's information so we can ensure a great summer camp experience!

Camper's Name(Required)

First Last

Please list all allergies, plus reaction and treatment.(Required)

Please list any medical conditions that are pertinent to their camp experience.(Required)

Please list any dietary restrictions.(Required)

First Guardian Information(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please identify 2nd guardian and/or emergency contact(Required)

First Last

Phone(Required)

If you have additional caregivers you wish to list for pickup, please list their first/last name and phone number below:

Is there anything we need to know about your child to ensure s/he has the best possible experience?