Health Information and Permission Form

MacPhail Summer Camps Minneapolis

Student Name*

Parent First Name*

Parent Last Name*

Email*

Phone number*

Which MacPhail Camp are you attending?*

Emergency Contacts

Emergency Contact Name*

Emergency Contact Phone Number*

Contact # 2 Name*

Contact #2 Phone Number *

Health Care Information:

Does your child have any allergies (food, medicines, fabrics, art supplies, etc)?*

Is the student on any prescription medication that will need to be administered during the camp session?*

Does your child have any physical/emotional/special needs that our staff should be aware of to help your child have a successful and enjoyable camp experience?*

Permission Form

As the parent or legal guardian of

Student Name*

I give my permission for the following:

MacPhail staff and teachers may take my child outside for breaks, or short walks to a local park.*

Yes