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INTERNATIONAL
MEDICAL FORM

Sorry for the boring stuff...

But safety is a priority on our camps, and we want to ensure that everybody is covered should something go wrong!

First name*

Last name*

Email*

Phone*

Camp I am attending*

Date of birth

Sex

Male

Female

Address*

Emergency Contact*

Phone*

Relationship

Medical Conditions/Disabilities*

Past Injuries/Illnesses/Surgeries*

Medications (including emergency)*

Allergies*

Additional assistance requirements (please specify)

Anything else we should be aware of

Insurance Provider*

Policy Number*

I confirm the information provided is complete and accurate to the best of my knowledge and that I am fit to take part in the camp.

Date Signed*

BECOME A MEMBER

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