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TEEN CAMP 2026
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Name of camper *
Date of birth *
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YYYY
Gender *
T-shirt size *
Dietary requirements *
School Year in 2026 *
Local church where you place membership *
Will you need the bus from the airport *
ParentGuardian email *
Parent/Guardian name *
ParentGuardian number *
Parent/Guardian address *
Emergency Contact (other than parent guardian) *
Relationship to emergency contact *
Emergency contact number *
Name of physician *

Physician Contact Number

 *

Medicare Number

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Private Insurance Company (if applicable)

Member Number (if applicable)

Allergies - List all known and describe how each reaction is managed

 *

Medication - List all taken alongside their Dosage, Frequency and Reason (if none, write none)

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Date of last tetanus immunization

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MM
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DD
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YYYY
Has the camper had any recent injury, illness or infectious disease (if yes, please explain using 'other')
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Does the camper have any medical conditions?

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Has the camper been diagnosed with any mental health disorder? 

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I confirm as the parent/guardian of the Teen Camper, I have read, consent and agree to the following statement while providing correct information and being of legal age. I verify that my child is both physically and mentally healthy to attend the 2026 SPA Teen Camp.
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