Camp Counselor Health Evaluation Form
Complete this health evaluation to confirm your fitness and readiness for camp counselor duties. All responses are confidential.
Full Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you experienced any of the following symptoms in the past 14 days? (Check all that apply)
*
Fever or chills
Cough
Shortness of breath
Sore throat
Loss of taste or smell
None of the above
Are you currently taking any medications?
*
Yes
No
Please list any current medications (if none, write 'N/A')
*
Do you have any allergies (e.g., food, medication, environmental)?
*
Yes
No
Please list any allergies (if none, write 'N/A')
*
Have you received all required immunizations for camp employment?
*
Yes
No
Not sure
Do you have any physical or medical conditions that may limit your camp activities?
*
Yes
No
Submit Evaluation
Should be Empty: