Family Camp Medical Form

Family Camp Medical Form
Complete a separate medical form for each person in your group by 1st March.
Family Member Details
Family Member Status
Full Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Can swim 50m fully clothed?
On Camp Contacts
On-camp Contact 1 Name
First NameLast Name
On-camp Contact 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
On-camp Contact 1 First Name
On-camp Contact 1 Last Name
On-camp Contact 2 Name
First NameLast Name
On-camp Contact 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts
Your emergency contacts must not be present on camp
1st Emergency Contact Name
First NameLast Name
1st Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Emergency Contact Name
First NameLast Name
2nd Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical and Dietary Details
Doctor's Name
First NameMiddle NameLast Name
Surgery Name and Town
Medical Information for First Aider
Dietary Requirements
Should be Empty: