Camp Medical Release Form
Coach Dwyer's Adventure Camps Medical Release Form
Campers Last Name/ First Name *
Campers Birthdate
Campers gender
Address (street address, city, state)
Parent last name/first name *
parent phone *
cell/home
Emergency contact name and relationship to camper
Emergency contact number *
Campers Doctor
Doctors phone number
List any medical conditions or concerns over the past 2 years
any activity restrictions by parent/physicians advice
Allergies *
Required
please explain allergies and medicines they need at camp
First Aid may be administered to my child, as needed, by designated camp staff *
Submit
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