Camp Medical / Authorization Form

Camp Medical Release / Authorization Form

"*" indicates required fields

Gymnast / Camper Information

Name

First Last

Birth Date

Which week of Camp(s) are you attending?

Contact Information

This form is being completed by

Name*

First Last

Primary Phone #*

Email*

Primary Emergency Contact Information

In Case of Emergency, Please Contact:

Name

First Last

Primary Phone #

Relationship

Secondary Emergency Contact Information

Name

First Last

Primary Phone #

Relationship

Doctor Information

Doctor's Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Doctor's Phone #

Your Insurance Carrier

Group #

Policy #

Please list all medications the gymnast is currently taking

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.

Please tell us what medication you will be providing and when you would like your child to receive their dosage

Does your child have any allergies? If yes, which ones?*

Release & Policies

Digital Signature*

Comments

Camp Medical Release / Authorization Form

Gymnast / Camper Information

Contact Information

Primary Emergency Contact Information

Secondary Emergency Contact Information

Doctor Information

Medical Information

Release & Policies

LOCATIONS

CONTACT

QUICK LINKS

Now Accepting Registrations for the Following
Camps & Events:

Winter Wonderland Day Camp – –
December 26th – December 30th, 2022

Kids Night Out Glow in the Dark Party – –
Saturday January 7th, 2023

Upcoming Scheduled Closures:
December 23rd – January 1st
March 3rd – March 5th
April 10th – April 15th
May 26th – May 29th
July 4th