Schoharie Valley Community Camp Staff/Volunteer Medical History & Background information
As a Day Camp Program we are required to obtain the medical history and run background checks of all Day Camp Staff and Volunteers. Please fill out this form by July 2nd so that the background checks can be completed before the first day of camp. Questions? Please contact us at SchoharieValleyCommunityCamp@gmail.com Please know that this information will be kept confidential except in the case of emergency
Email address *
Health Information
Are your immunizations currently up to date? *
Please list any allergies, special dietary needs, or specific illnesses that we should be aware of:
Your answer
Please list any Medications you are currently taking:
Your answer
Background Information
Full Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Driver's License Number (if applicable)
Your answer
Have you ever been convicted of a felony? *
If yes, please explain and give date:
Your answer
Signature
I hereby attest that the above information is up to date and accurate to the best of my knowledge and that failure to produce accurate information could result in my inability to be a staff member or volunteer for the Schoharie Valley Community Camp. My typed response below acts as my signature.
Electronic Signature *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.