CAMPER EMERGENCY CARD

CAMPER's NAME_____________________________________________

ADDRESS__________________________________________

PHONE NUMBER__________________________________________

BIRTHDATE_______________________________________________

CONTACTS:

CONTACT#1____________________________RELATIONSHIP_____________________

PHONE #1____________________________________________________________________

PHONE #2____________________________________________________________________

CONTACT #2____________________________ RELATIONSHIP_____________________

PHONE #1____________________________________________________________________

PHONE #2____________________________________________________________________

MEDICAL CONCERNS:

Pediatrician's Name: _________________________________________________________

Pediatrician' Name: __________________________________________________________

ALLERGIES__________________________________________________________________

SPECIAL MEDICAL CONCERNS ________________________________________________

Medications Taken at Home : _____________________________________________________

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