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CAMP ONIDAH
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Medical Form
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Camper's First Name
Camper's Date of Birth
Phone
Camper's Last Name
Camper's Age
phone type
Email Address
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact's Phone
Does the camper have any allergies?
*
Yes
No
Please explain
Does the camper require a special diet?
*
Yes
No
Please explain
Will the camper be using any medication or over-the-counter drugs?
*
Yes
No
Please explain
Does the camper have a chronic or recurring illness?
*
Yes
No
Please explain
Has the camper had surgery or a serious illness in the last 12-months?
*
Yes
No
Please explain
Other physical limits or accomodations:
Permission
I acknowledge and agree with the statement above
Camper Conduct
I acknowledge and agree with the statement above
Disclaimer Clause
I acknowledge and agree with the statement above
Description of RISKS
I acknowledge and agree with the statement above
RELEASE OF LIABILITY WAIVER OR CLAIMS AND INDENMNITY AGREEMENT
I acknowledge and agree with the statement above
Media Release
I acknowledge and agree with the statement above
Camper Signiture
Clear
Date of signing
Guarding Signiture (if under 18)
Clear
Date of signing
Submit
Thanks for submitting!
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