Craven Complete Camp Health Form- Craven Complete

effect have put

Name

First

Last

D.O.B

Which camp are you attending?

Please can you answer the following question honestly? This helps us to give you the best camp we can.

If you are not honest with these answers, it could lead to you not being fit for camp or you not having the best time

Do you have anything wrong with your heart

Yes
No

Do you have an respiratory condition eg Asthma COPD

Yes
No

Are you diabetic

Yes
No

Do you have any neurological condition eg epilepsy

Yes
No

Do you have any joint problems?

Yes
No

Have you had any recent surgery or one we should be made a wear of?

Yes
No

Do you have any other medical conditions that might effect you being on camp or needed extra support?

Yes
No

Are you on any prescription medication?

Yes
No

If you have answer yes to any of the above please put more detail in this box

By signing this box you have truthly answered all question, if you are found to have not disclocced a condition before camp, we can not be help responsible for your camp experience and you might not be able to participate in all activities

Clear Signature