Health Form Portion of Registration

Health Form 2023

Camper's Full Name *

First, Middle, and Last

Gender *

Male
Female

Birthdate *

Age (while at camp) *

Parent/Guardian's Name *

First

Last

Parent's E-mail Address

Medical Information

Any known health or behavioral concerns?

Other Information (anything else you would like us to know about your child’s behavior or physical, emotional, or mental health including activity restrictions.):

Any Drug Allergies?

Food Allergies/ Restrictions? (If food modifications are significant, please contact us to make prior arrangements. You may be asked to provide easy-to-prepare substitutions.)

Other Allergies?

Insurance Company

Policy Number

Primary Care Physician

Phone Number

(Our insurance will not cover any pre-existing conditions. In case of accident or injury, your insurance will be considered primary. Camp Ozone insurance will be submitted as secondary.)

________________________________________________________

Bring Medication and completed Medication form (from confirmation packet) in a gallon-sized storage bag to check-in. You must bring current medication in its container with instructions.