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
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.
Click here to Print exemption form
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.
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?

Status message

The following questions will be asked at drop off each day. Each day please take your childs temperature and ask these questions before leaving for camp.

  1.  Is the campers temperature above 100.4 degree F?
  2. Has anyone in the household had contact with a confirmed COVID case in past 10 days without taking CDC procautions and proper PPE?
  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. Has anyone in your family/camper been to a hotspot or state in the past 10 days?
  7. Has anyone in your household had COVID-19 positive test or have suspected Covid-19 in the last 14 days.
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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