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Medical Waiver Form

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Medical Waiver Form
Medical Waiver Form
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Medical Waiver Form
This form MUST be completed and returned to the Camp prior to YOUR participation in the
selected camp. YOU WILL NOT BE ADMITTED WITHOUT THIS FORM COMPLETED IN ITS
ENTIRETY.
Camp Details
Camp Name: _______________________________________ Camp Date: ____________
Camp location: ____________________________________________________________
Camper Details
Campers Name: ____________________________ Date of Birth: ________ Age: ______
Camper Address: __________________________________________________________
Emergency Contact
Contact 1
Name: __________________________________________________________________
Phone #: ____________________________ Cell Phone #: ________________________
Address: _________________________________________________________________
Email: _________________________________________
Contact 2
Name: _________________________________________________________________
Phone #: ____________________________ Cell Phone #: _______________________
Address: ________________________________________________________________
Email: _________________________________________
Medical Waiver Form
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