Health Form | redwood-1

Camper First Name

Camper Last Name

Birthday

Medicare Card #

Expiry

Parent/Guardian Phone Number

Emergency Contact

Health History

Other

Allergies

Other

Severity of Allergies

Mild

Moderate

Severe

Immunizations to date

Yes

No

Epipen needed?

Yes

No

COVID-19 vaccine?

Has your child required behavioral counselling?

Yes

No

If yes, please share any information you feel comfortable with.

Dietary or activity restrictions for camp:

Medication to be given at camp (must be in original bottle):

Other Medical, Physical , Emotional or Behavioral Concerns and/or Recent Operations, Illness or Injuries

To the best of my knowledge, my child is healthy and has not been exposed to infectious diseases in the past 4 weeks. I will notify the camp in writing of any health status changes or exposure to infectious diseases. I have disclosed all pertinent medical information, including prescription medications. In case of emergency and if we are not available, I give permission to the camp's physician to hospitalize, treat, and order injections, anesthesia, or surgery for my child.

Summer Fun since 1974

Important Health Info!