CREATE 2021 Summer Camp Health Form
Please complete the following form regarding your child's health history accurately and to the best of your knowledge. You will need to complete a separate form for each registered child. If you would like to discuss any health concerns, please contact us at 301-588-2787 or
Email address *
Last Name of Child Attending Camp *
First Name of Child Attending Camp *
Date of Birth *
Gender *
Camp Sessions *
Please check ALL sessions for which your child is registered:
Name of Parent/Guardian Completing and Submitting Form *
Allergies *
Please check boxes for any known allergies
If your child has an allergy listed above, please describe the allergy, typical reactions seen, and medications taken.
Will your child require any medications while at camp? *
All medications brought to camp must be clearly labeled with child's name and any instructions for use. Unless otherwise indicated, medications will remain in the office during the day.
If you answered "YES" to the previous question, please provide the name of medication(s), dosage, and instructions.
Additional Information
Please share any learning differences, notes about your child’s behavior, strategies that work well inschool and at home, etc. This will help us to ensure that we can help your child have the best possible experience at CREATE!
I understand that: *
Please check each box below to indicate that you have read and understand the following.
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