Summer Camp Health Form

Camp Health Form

  • Please list name, phone number, and email to contact you in case of an emergency
  • Please list name, phone number, and email to contact in case of an emergency
  • List of all people authorized to pick up your child. Please include a contact phone number as well
  • Does your child have any allergies we should be aware of? (Seasonal, Dietary, or Medications)?
  • Does your child have any social challenges we should be aware of? (Anxiety, ADD, ADHD, Spectrum Disorder)?
  • Does your child take any medication we should be aware of?
  • I grant my child permission to participate in supervised outdoor activities in the field adjacent to STL Rock School’s parking lot.
  • I hereby give permission for STL Rock School to use their judgment in arranging for my child’s emergency medical care in the event that I or my emergency contacts cannot be reached. I authorize STL Rock School to take necessary action for the welfare of my child. I further agree to pay all expenses involved and/or make insurance arrangements.