Youth Education Camper Health History

(Enter in the format of uXXXXXXX)

(Select all that apply)

If you would like to provide more information about your child (including additional mental or health details), please fill out this form.

Parent/Guardian Authorization for Healthcare

This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted here. I attest that I have reviewed the camp program and its activities with the camper described above. I further understand and acknowledge that the information on this form will be shared on a “need to know” basis with camp staff. I give my permission to make photocopies of this form. In addition, the camp has permission to obtain a copy of this camper’s health record from providers who treat my child and these providers may talk with the program’s staff about my camper’s health status.
Parent/Guardian Information