Sports Camp Medical Release Form
Complete this form to provide the participant’s medical details, emergency contacts, and authorization needed for camp participation.
Participant and Guardian Information
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Participant
*
Parent
Guardian
Other Caregiver
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Medical Profile
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Known Allergies
*
Current Medications, Dosage, and Instructions
*
Relevant Medical Conditions, Injuries, or Restrictions
*
Physician or Clinic Name
Physician or Clinic Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Release and Authorization
Parent/Guardian Signature
*
Submit
Submit
Should be Empty: