Camper Health Form

Camper's First Name(*)

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Camper's Last Name(*)

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Health Card Number(*)

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Any special instructions in caring for your child

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Family Doctor Name(*)

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Family Doctor Phone Number(*)

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Does the camper have any allergies?(*)

Yes No Invalid Input

If yes, what are they?

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Does the camper require an EpiPen?(*)

Yes No Invalid Input

If yes, has one been provided?

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If yes, does the camper carry the EpiPen with them?

Yes No Invalid Input

Name of Parents/Guardians camper lives with(*)

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Emergency contact 1 home or cell number(*)

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Emergency contact 1 work number

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Emergency contact 2 home or cell number(*)

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Emergency contact 2 work number

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Every effort will be made to contact the persons above, but in the event of that they are not being available please provide an alternate contact person.

Alternate person(*)

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Relationship(*)

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Alternate person home or cell number(*)

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Alternate person work number

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Note: We are a Nut Aware Facility and make reasonable effort to ensure the food we serve is Nut Free. PLEASE respect this standard and ensure that the food you send is NUT FREE.

Verification(*)

The above information is complete and accurate to the best of my knowledge. Invalid Input

Your First Name(*)

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Your Last Name(*)

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Child Protection Policy www.insafehands.ca is our protection policy to ensure our camps are safe places.

ENSURING COMPLIANCE WITH PRIVACY LAWS Privacy Policy: The One Hope Canada/Monarch Bible Camp Privacy Policy applies to any and all people whose information is collected for any reason. https://onehopecanada.ca/privacypolicy/

Revised Nov. 2021

Captcha(*)

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