Health Background Information

Health Background Information

Step 1 of 3

BACKGROUND INFORMATION

Name of Child(Required)
MM slash DD slash YYYY
Parents/Guardians(Required)
Name
Address(Required)
Physician(Required)
Name
Phone

GOALS FOR YOUR CHILD

Camp(Required)
Organized Sports Teams or Group Activities(Required)
General Movement and Having Fun(Required)

EMERGENCY CONTACT

Emergency Contact(Required)
Name
Phone