March Break & Summer Camps - Medical Form | The Royal Conservatory of Music

Oscar Peterson School of Music - Camps Medical Form

Please fill out and submit a medical form for reach camper before their first day at camp. This information is referred to in case of a medical emergency and is retained by the Oscar Peterson School only for the duration of your camper's time at camp.

Child's Information
Child's First Name
Child's Last Name
Preferred Name/Nickname
Languages Spoken
Primary Phone Number
Birthdate
Address
Address 2
City/Town
Province
Postal Code
T-Shirt Size
Camp
Parent/Guardian Contact Information
#1
Parent/Guardian First and Last Name
Parent/Guardian Email
Primary Phone Number
Additional Phone Number
#2
Parent/Guardian First and Last Name
Parent/Guardian Email
Primary Phone Number
Additional Phone Number
Additional Pick-Up Information
Please include the names of 1-2 additional guardians who are permitted to pick-up your camper. For your safety, campers are not permitted to be sent home with a guardian who is not included on their approved pick-up list, including family/guardians of other campers, and all approved guardians must be above the age of 13. Any additional pickup names must be sent in advance in writing to [email protected] and confirmed by the Programs Coordinator for approval.
#1
Pick-Up First and Last Name
Phone Number
Relationship to child
#2
Pick-Up First and Last Name
Phone Number
Relationship to child
Sign-In/Sign-Out Permissions
Children under the age of thirteen (13) must be accompanied by a parent/guardian at all times until they are signed in or signed out of programming by a parent/guardian. Children under the age of 13 will also be required to bring a packed lunch each day and will be provided with a supervised lunch period. Children 13 years and older are permitted to sign themselves in and out of camp with consent given by a parent/guardian. The RCM does not assume any responsibility for the well-being and safety of minors who are left unattended on school premises.	My child is over the age of 13 and is permitted to sign themselves in and out of programming. My child is over the age of 13 and is not permitted to sign themselves in and out of programming. My child will be signed in and out of programming by a parent/guardian. My child is under the age of 13 and will be signed in and out of programming by a parent/guardian.
Medical Information
Health Card Number
Please list any allergies or medical information we should be aware of:
Does your child require an EpiPen?	Does your child require an EpiPen? Yes No
Has your child recently had a cold/flu/infection?	Has your child recently had a cold/flu/infection? Yes No
Does your child have any behavioural/social/emotional needs?	Does your child have any behavioural/social/emotional needs? Yes No
Please provide any additional information/comments about your child you feel our staff should be aware of (i.e., behavioural tips/strategies):
Medical Restriction(s) Acknowledgement
I hereby certify that there are no medical restrictions or concerns prohibiting my child(ren) from participating in any day camp activities. Should the need arise, permission is granted to The Royal Conservatory and/or its representative to transport my child(ren) to a local hospital for medical treatment if necessary.
Parent/Guardian Full Name
Signature	Reset

March Break & Summer Camps - Medical Form

Child's Information

Parent/Guardian Contact Information

#1

#2

Additional Pick-Up Information

#1

#2

Sign-In/Sign-Out Permissions

Medical Information

Medical Restriction(s) Acknowledgement