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Official Medical Release Form

Medical Release Form/Permission to Treat
ALL students, regardless of age, must have this form signed by a parent/guardian prior to camp.

Important: Please Read

STEP 1

STEP 2

Please supply ALL of the following information.
Attach a copy of your insurance card (front and back) to expedite medical treatment.

Upload Insurance Card

STEP 3

Physical Limitations (asthma, diabetes, allergies, etc.) and/or special instructions
(allergic to certain meds, rare blood type, wears contact lenses, etc.)
List ALL medication taken on a regular basis:

List ALL medications brought with you to Camp.
Prescription meds MUST have a pharmacy label and name of doctor.
Please bring them in a Ziploc bag with your name on it:

List all operations/serious injuries (including the date of each) within the past five (5) years:

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