Camp/Conference Medical Consent and History
This form must be completed for each resident prior to checking into a room.
Please state the camp or conference the resident is attending *
Resident's First Name *
Your answer
Resident's Last Name *
Your answer
Resident's Cell Phone Number *
Your answer
Resident's year in school Fall 2019 *
Your answer
Resident's current school *
Your answer
Identified Gender *
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Name of person to be notified in an emergency *
Your answer
Cell phone number of person to be notified *
Your answer
Please list any relevant medical concerns the resident has.
Your answer
Please list any allergies the resident may have.
Your answer
Please list all medication that the resident will bring.
Your answer
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