Camp Health Form 2023

First and last name

Group Name (if applicable)

Mailing Address

Do you have any health or mobility conditions that might limit your involvement during the camp week? If your answer was yes, please give us more information.

Do you have any allergies that we should be aware of? If your answer was yes, please give us more information.

Are there any dietary restrictions that we should be aware of for the week of camp? If you answered yes, please specify so we can make proper arrangements.

Insurance provider

Insurance provider phone number

Emergency contact

What is their relation to you? (i.e. mother, sister, husband)

Emergency contact email

Emergency contact phone number