Ferntop Camper Emergency Information
Please submit a separate form for each child attending.
Email address *
Choose your camp / camps *
Child's Name *
Child's Birthday *
Child's Age when camp begins *
Parent/Guardian's Name *
Parent/Guardian’s Mobile Phone Number *
Is this the primary contact number to be used by Ferntop? *
If no, please type the primary contact phone number in the "Other" field.
Who is authorized to pick up your child? Please list all names on this line. *
If we can't reach a parent or guardian who should we call in the event of an emergency? Please list at least 2 names and phone numbers. *
If the emergency contacts are the same as those authorized to pick up your child, you may type Same as Above.
Any food, environmental, or medical allergies? *
If yes, please describe.
Has your child ever been stung by a bee? *
If so, was there an allergic reaction? please explain.
Does Ferntop have your permission to administer Benadryl if your child has an allergic reaction to a bee sting? *
Any special needs or diagnoses? *
If yes, please describe.
Pediatrician Name *
Pediatrician Phone Number *
Preferred Hospital *
Any written medical instructions that should be on file? *
In case of an emergency, every effort will be made to reach the parents or authorized people listed above. If none of these people can be reached, do you give Ferntop teachers/staff permission to obtain medical attention for your child? *
Camp is filled with many great video/photo opportunities that may be used on our website, social media, or other projects. (We won't share your child's name.) *
How comfortable is your child with the outdoors? *
Not at all comfortable
Very comfortable
If your child is not comfortable outdoors, can you describe?
Is there any other information you wish to share about your child?
A copy of your responses will be emailed to the address you provided.
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