Camper Health & Info Form - Chabad of the Bay Area

After you have filled out the Camp Application , please fill this camper health & info form out as well.
Any questions? Don't hesitate to call Malky at 713-398-7124 or email [email protected]
Parent & Camper Info
Parent filling out this form*
First NameLast Name
E-mail*Primary email
Child*
First NameMiddle NameLast Name
Age*
Interests, talents, etc.Or anything else you would like the counselor to know
Any Health IssuesAny health issues you would like us to be aware of
Health & Emergency Contacts
If any health or wellness issue arises, we will contact one of the parents. In case of emergency, or where the parents cannot be reached, please provide doctor, insurance and an additional emergency contact below.
Health Insurance Info*Insurance name, type and policy number
Pediatrician*Name and contact info for child's doctor
Emergency Contact*Name and number for backup contact in case parents cannot be reached
Comments
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Parent & Camper Info