Medical Camp Permission Form
Please fill out this form to grant permission for participation in the medical camp.
Participant's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian's Full Name
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Conditions or Allergies
*
Permission Granted
*
Yes, I grant permission
No, I do not grant permission
Signature of Parent/Guardian
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: