Camper Physical Examination Template
| Dose 1 (Month/Year) | Dose 2 (Month/Year) | Dose 3 (Month/Year) | Dose 4 (Month/Year) | Dose 5 (Month/Year) | Most Recent Dose (Month/Year) | |
|---|---|---|---|---|---|---|
| MMR | 1/2018 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| IPV | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| DTaP | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| Tdap | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| HIB | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| PCV | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| Hepatitis B | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| Hepatitis A | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| Varicella | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| Meningococcal B | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
| 2vHPV, 4vHPY or 9vHPV | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 | 1/2019 |
If your summer camp requires physical examinations before each session, use this free Camper Physical Examination PDF Template to easily collect confirmation of exams from licensed medical providers. Each entry will be converted into a secure PDF that contains a camper’s medical information and a healthcare provider’s signature.
This camper physical examination template requires a camper’s personal information, immunization history, allergy diagnosis, dietary restrictions, and medications. Using our PDF Editor, you can customize your template to ask for additional health information. By automatically saving summer camp physicals as PDFs that are easy to organize, share, and print, you can make sure each camper is healthy enough to safely participate in this summer’s activities.
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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.