Volunteer Medical Form
Every volunteer must complete this form and submit prior to camp. For questions, please contact: Jill Waddell: campweekaneatit@gmail.com
MUST BE SUBMITTED BY APRIL 15, 2019
Name
Date of birth
Primary Doctor
Primary Doctor's Contact Information
Insurance : (please upload copy of card)
List any surgeries you have had with dates
Do you have celiac disease/date of diagnosis
Other Medical Conditions
Do you have asthma
List all current medications
List all medication allergies
Do you require an epi pen
List all food allergies and reaction to each
List all other allergies
List all dietary restrictions
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service