Health History Form Part 4 contains information about a Camper or Staff Member's Emergency Contact, Health Care Providers, General and Mental Health, and Authorization for Health Care.
- Emergency contact name
- Emergency contact relationship to Camper of Staff Member
- Emergency contact phone numbers
Health Care Providers
- Primary Doctor name and phone number
- Detest name and phone number
- Orthodontist name and phone number
Parent / Guardian Authorization For Health Care
The Parent / Guardian Authorization For Health Care section confirms that consent has been given for a Camper to receive medical treatment as necessary. This section appears only on the Camper Health Form and is not applicable to Staff. Please note that camper Health History From Part 4 cannot be submitted if consent is not given in this section.
- Initials of person completing the form
- Click "Submit form" to submit the information entered above