Rockpoint Community Church - Health Form

Rockpoint Community Church
CROSSROADS HEALTH FORM

It is very important that you fill out this form as completely as you can. Thank You!

First Name

Last Name

Primary Emergency Contact

First Name

Last Name

Relationship to Camper

Email

Phone Number

Secondary Emergency Contact

First Name

Last Name

Relationship to Camper

Email

Phone Number

Please share any concerns you may have (anxiety, autism spectrum, development, etc.)

Does this camper have a severe allergy, and require special attention for it?

Yes

No

Allergies (please list all of concern)

May we administer medicine (provided by parent/guardian) in accordance with their allergic reaction plan? (We will always call first)

Yes

No