HEALTH FORM 

Name __________________________________________________

Address_________________________________________________

City/St/Zip ______________________________________________

IN CASE OF EMERGENCY NOTIFY

Name/Address ____________________________________________

______________________________________ Phone ____________

Relationship ______________________________________________

Medication taken at camp: ___________________________________

_________________________________________________________

Do you have a Medic Alert necklace or Bracelet?  Yes _____ No ____

Dr. name/address/phone #: ___________________________________

_________________________________________________________

Signature: ___________________________________  Date: ________

Please bring with you when you register.

Campers are insured in case of accident as long as they are on the grounds.

The insurance does not cover if you leave the grounds.