Health History

Camper Information
Child's Information
Campers Current Residence
Please click below on the week(s) of camp(s) your child is registered to attend
Week #1
Week #2
Week #3
Week #4
Week #5
Week #6
Week #7
Week #8
Week #9
Week #10
Team Week
Emergency Contact Information
2nd Emergency Contact Name OTHER than listed above:
Health Information
You MUST provide the Camper Medical Authorization Form  in this link and it MUST be signed by a Physcian ​​​​​​. School Forms will not be accepted.

Campers with Asthma must fill out this form by a Physcian Asthma Action Plan
If your child has a medical concern listed above, We must ensure that the camper’s parent has discussed camp attendance with the camper’s health care provider. Have you discussed camp with your child's health care provider?
Immunization Information
All campers who reside outside of the United States, must provide our office with a completed DHMH-896 form (record of vaccination or immunization) 7 days prior to their first day of camp.

Status message

Right click here and open in new tab for Exemption form.  This must be filled out and turned in 2 weeks prior to the start of camp

This form will need to have the child information filled out at the top of the first page. Then at the bottom of the first page there is a place to fill out for excemptions. 
Your Information
Name of person completing this form:
Provide signature above. Works best on mobile devices.

Status message

The following questions should be asked before coming to camp. 

  1. Has anyone in the household or  someone they been in contact with test positive for Covid in the past 10 days?
  2. Is anyone the in the household or anyone they have been in contact with awaiting Covid test results?
  3. Does the camper have cough, fever, chills, shortness of breath, body aches, congestion, runny nose, unusual headaches, fatigue, cough, sore throat in the last 48 hours?
  4. Has the camper had new loss of taste or small in the last 48 hours?
  5. Has the camper vomited or have nausea in the last 48 hours?
  6. Is anyone in the household or someone they have been in contact with sick with any of the above symptoms in questions 3-5?
If you respond yes to any of these questions please do not send your child to camp as we can not accept them. 

Please ensure your child has washed their hands thoroughly before leaving home and upon returning home. 

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