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