Medical Waiver Form printable pdf download

Medical Waiver Form

This form MUST be completed and returned to the Camp prior to YOUR participation in the

selected camp. YOU WILL NOT BE ADMITTED WITHOUT THIS FORM COMPLETED IN ITS

ENTIRETY.

Camp Details

Camp Name: _______________________________________ Camp Date: ____________

Camp location: ____________________________________________________________

Camper Details

Campers Name: ____________________________ Date of Birth: ________ Age: ______

Camper Address: __________________________________________________________

Emergency Contact

Contact 1

Name: __________________________________________________________________

Phone #: ____________________________ Cell Phone #: ________________________

Address: _________________________________________________________________

Email: _________________________________________

Contact 2

Name: _________________________________________________________________

Phone #: ____________________________ Cell Phone #: _______________________

Address: ________________________________________________________________

Email: _________________________________________

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Medical Waiver Form