CREATE No School Day Camp Health Form

PLEASE COMPLETE AND SUBMIT THIS FORM NO MORE THAN 48 HOURS BEFORE THE START OF THE CAMP DAY.

IF YOU ARE SIGNING UP FOR MULTIPLE CAMP DAYS YOU WILL NEED TO COMPLETE A NEW FORM BEFORE EACH REGISTERED CAMP DAY.

Please complete the following form regarding your child's health history accurately and to the best of your knowledge. You will need to complete a separate form for each registered child. If you would like to discuss any health concerns, please contact us at 301-588-2787.

Email address *

Last Name of Child *

First Name of Child *

Date of Birth *

YYYY

Gender *

Female

Male

Prefer not to say

Other:

Date of No School Day Camp Session *

YYYY

Name of Parent/Guardian Completing and Submitting Form *

Allergies *

Please check boxes for any known allergies

No Known Allergies

Food Allergies

Medicine Allergies

Environmental Allergies (pollen, bee stings, etc)

Other Allergies

Required

If your child has an allergy listed above, please describe the allergy, typical reactions seen, and medications taken.

Will your child require any medications while at camp? *

All medications brought to camp must be clearly labeled with child's name and any instructions for use. Unless otherwise indicated, medications will remain at the front desk with the CREATE staff member.

Yes

If you answered "YES" to the previous question, please provide the name of medication(s), dosage, and instructions.

Additional Information

Please share any learning differences, notes about your child’s behavior, strategies that work well inschool and at home, etc. This will help us to ensure that we can help your child have the best possible experience at CREATE!

Never submit passwords through Google Forms.

This form was created inside of CREATE Arts Center Inc.. Report Abuse

Forms