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Health History Form Part 4

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 Contacts

Emergency Contacts
  1. Emergency contact name
  2. Emergency contact relationship to Camper of Staff Member
  3. Emergency contact phone numbers

Health Care Providers

Health Care Providers
  1. Primary Doctor name and phone number
  2. Detest name and phone number
  3. Orthodontist name and phone number

General Health Questions

General Health Questions
  1. General Health Questions
  2. General Health Notes

Mental Health Questions

Mental Health Questions
  1. Mental Health questions
  2. Mental Health notes

Parent / Guardian Authorization For Health Care

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.

  1. Initials of person completing the form
  2. Click "Submit form" to submit the information entered above

 

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