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

March Break & Summer Camps - Medical Form

I am submitting this form for:
Child's Information
Child's First Name
Child's Last Name
Home Phone Number
Birthdate
Address
Address 2
City/Town
Province
Postal Code
Camp
Parent/Guardian Contact Information
#1
Parent/Guardian First and Last Name
Parent/Guardian Email
Home Phone Number
Cell Phone Number
#2
PARENT/GUARDIAN FIRST AND LAST NAME
Parent/Guardian Email
Home Phone Number
Cell Phone Number
Pick-Up List/Alternative Emergency Contact
#1
Pick-Up First and Last Name
Phone Number
Relationship to child
#2
Pick-Up First and Last Name
Phone Number
Relationship to child
For your child’s 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. any additional pickup names must be sent in advance in writing to [email protected] and confirmed by programs coordinator for approval.
Medical Information
Health Card Number
Please list any allergies or medical information we should be aware of:
Does your child require an EpiPen?	Yes No
Has your child recently had a cold/flu/infection?	Yes No
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:
Medical Restriction(s) Acknowledgement
I hereby certify that my child has no medical restrictions or concerns prohibiting him/her 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 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

Pick-Up List/Alternative Emergency Contact

#1

#2

Medical Information

Medical Restriction(s) Acknowledgement