List any/all allergies including food, medications, insects, other and note desired response if exposure (i.e. Call 911, epipen, only mild reaction to watch, etc.) If none, note "none."
List any medical conditions that we need to know about.
Please list any medications your child is currently taking. If none, note "none."
To the best of my knowledge, my child is physically able to participate in summer camp.
In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to the nearest appropriate emergency medical care facility. Furthermore, I give consent for the facility to secure any and all necessary emergency medical care for my child.
Please provide doctor's name and phone number.