Parent/Child Questionaire

Camper First Name *

Camper Last Name *

Camper Birth Date * +

Parent Cell: *

Parent Email: *

Does your child have allergies? *

Yes

If yes, what is the allergy and how is it treated? *

Does your child have asthma? *

Yes

If yes, what triggers the asthma and how is it treated? *

Does your child have any physical or learning disability, or other special need? *

Yes

If yes, please explain. *

Does your child have ADD, ADHD, OCD or seizure disorder? *

Yes

If yes, please explain. *

Any medication, prescription or over the counter, that needs to be administered on a scheduled or as needed basis will need orders written by your physician. A parent/guardian will need to bring the medication and the orders to the Nurse's Office at the beginning of camp. This is in compliance with the Department of Health and NYS Camp Association.

Please tell us any information regarding your camper that you feel would be important for us to know in order to ensure a great camp experience. *