Student Health Form
The following information must be completed in its entirety In order for any child to attend camp. The questions are divided into 3 parts: personal information, health and wellness. Please be honest and thorough as possible. This information should be completed by September 19th.
What school does your child attend? *
Who is your child's teacher? *
Student's Name (Last, First) *
Your answer
What is your child's birthdate?
MM
/
DD
/
YYYY
Student Gender *
What is your child's height? *
Your answer
What is your child's weight? *
Your answer
What is your address?
Your answer
Home Phone Number:
Your answer
Parent Cell phone Number:
Your answer
Name of an Emergency Contact: *
Your answer
Phone Number for the Emergency Contact: *
Your answer
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