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.

I am submitting this form for:
Child's Information
Child's First Name
Child's Last Name
Preferred Name/Nickname
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 any 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. 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
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 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

Additional Pick-Up Information

#1

#2

Medical Information

Medical Restriction(s) Acknowledgement