Camper Health Information Form

Now that you've registered, we need to know some important things about your camper(s)! This information enables us to take any preventative and/or emergency measures required to ensure your camper's safety. Each staff member has First Aid, Accessibility, and CPR-C Training, and have gone through situational training with respect to various emergencies.

Your camper's health is our top priority, but so is your privacy. Health information will be kept strictly confidential and be used only in emergencies. Please note, if this form is not submitted within a week of registering, your spot will no longer be reserved. Should your spot be taken, your purchase will be refunded. Your camper cannot be legally admitted to camp without this form! 

Camp is a great and safe time, but we need to be prepared.

HEALTH INFORMATION FORM

General Information
Camper Name *
Camper Name
Date of Birth *
Date of Birth
Camper Name #02
Camper Name #02
Date of Birth #02
Date of Birth #02
Date of Birth #03
Date of Birth #03
Emergency Contact #01
Name *
Name
Address *
Address
Primary Phone Number *
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Emergency Contact #02
Name *
Name
Address *
Address
Primary Phone Number *
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Healthcare Information
Address *
Address
Phone Number *
Phone Number
Medical Form
Please be clear and concise. If you have registered multiple campers, please specify which campers has medical/special concerns and allergies.
Safety Information
Additional Information
How did you hear about ASUS Camps? *