Summer Camp Medical Release Form printable pdf download

Summer Camp Medical Release Form

SUMMER CAMP MEDICAL RELEASE FORM

Child’s Name __________________________________Age ________Birthday_______________

Name of Parent/Guardian__________________________________________________________

Daytime Phone #(s)_________________________________________________________________

Street Address City Zip ______________________________________________________________

In case of emergency when you cannot be contacted, list the name and phone

number of the person(s) to be called:

Name Phone # Relationship _________________________________________________________

Doctor’s Name Phone # _____________________________________________________________

Allergies (drugs, foods, insect bites, etc.)

_____________________________________________________________________________________

Current medication and reason(s) for taking

_____________________________________________________________________________________

Summer Camp Medical Release Form