Camp Medical Release / Authorization Form

Gymnast / Camper Information

Name
MM slash DD slash YYYY

Contact Information

Name

Primary Emergency Contact Information

In Case of Emergency, Please Contact:
Name

Secondary Emergency Contact Information

Name

Doctor Information

Doctor's Name
Address
Consent*

Medical Information

If it is necessary for your child to receive medication during the camp day, please do the following: 1. Send the medication to camp with a responsible individual (if you are unable to bring it) and give it to the camp coordinator. 2. Send the medication in the original container, properly labeled with the original pharmacy dosage information.
Consent*

Release & Policies

Consent*