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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