• Winter Camp Medical & Liability Release Form

    Winter Camp Medical & Liability Release Form

  • Camper Information

    All campers (adults and minors) on site must have a completed form on file.

  •  

    We want the most current medical information.

    If anything on this form should change between the time you fill it out and the time your camper arrives at camp, please notify our office at info@pondo.org.

     

  •  - -

  • Group Attending Camp With?

  • Parent or Guardian Information

  •  -
  •  -
  •  -
  •  -

  • Alternate Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts as we will alway seek to contact you first. List the name of another person who can be contacted in the event of an emergency or illness and you cannot be reached. Any person listed should be over 18, able to assist in contacting you, and be authorized to pick the child up from camp.
  •  -
  •  -

  • Medical / Health Information

  •  -
  •  - -
  • 0/150
  • 0/200

  •  

    Medication Requirements:

    1. All prescription medication must be in the original container with the camper's name on the label and include physician's instructions.
    2. Non prescription medication (allergery tablets, vitamins, etc) will be dispensed according to package directions. 
    3. All medication should be packed separetly and given to your group leader so that it can be checked in at registration.

    Campers are encouraged to keep in their possession Epi-Pens and Emergency Inhalers. Please clearly mark them with a permanent marker including the camper's name and group on the container as campers often misplace such items.

  • Basic Health Info

  • 0/150

  • Emergency Contact

  •  -

  • Add Ons!

    Help make the trip to camp OUTSTANDING! Please note that we are not liable for lost or stolen gift cards.
  • prevnext( X )

            Item subtotal:$0.00


            Item subtotal:$0.00


            Item subtotal:$0.00


            Item subtotal:$0.00

            Total $0.00

            Payment Methods

            creditcard
            After submitting the form, you will be redirected to Apple Pay to complete the payment.
            After submitting the form, you will be redirected to Google Pay to complete the payment.
            After submitting the form, you will be redirected to Cash App Pay to complete the payment.

          • If you would like to print the form for your records, please do so before submitting.

             

          •  
          • Should be Empty: