Medical Questionaire

We need to understand better your child’s health specifics for safety. Please go through the questionnaire and fill it in to the best of your knowledge.

Child's Full Name

Date of Birth

Parent's Email Address

Please list all known medical information, including any conditions that may require emergency care (e.g. asthma / epilepsy / dizziness / fainting spells / diabetes / hot conditions / hypertension / other condition)

Please list all known allergies

Is any medication to be administered for your child during the trip? If yes, state medication name and dosage.

Medical during program: please ensure all medication your brings is in its original packaging, clearly labelled with storage requirements, dosage and time of administration. You hereby authorize self-administration or teacher/guide administration.

Responsibility to update disclosures: I understand it is my responsibility to inform the camp organizer of any new medical conditions or change in this information provided.

Treatment consent: I hereby grant consent and my full authority to staff (or agents) of the program provider, to arrange for and grant consent to any medical treatment or hospitalization for my child while he and she is in care of the program provided.