We want to know more about your camper! As we begin placing campers together in bunks, we value your feedback and want to consider your camper’s unique tastes, interests, passions and quirks. Please take 2-minutes to tell us more about them.
Step 1 of 8 - Health History
Maximum number of allergies reached.
Maximum number of medications reached.
Parent acknowledgment and authorization: To the best of my knowledge, this Health History Form (including all related health forms collect, such as immunization, asthma, allergy and/or medication authorization) contains accurate information. I agree to contact Camp Encore/Coda (E/C) if this information changes before the start of the camp session. I understand that my final acceptance is contingent on E/C's receipt and review of all forms, including this one. I understand that providing inaccurate health information or falsifying health information can create serious risks to campers or others, and/or can result in a camper's dismissal from the program. I understand that although E/C may accept a camper into the program, ultimately, it is the parent's and camper's decision, in conjunction with their physician, to determine if E/C's activities are an appropriate match for the camper. Except to the extent limited in this and/or related health forms, or as directed by a parent, in writing, camper has permission to participate in all camp activities and programs. If applicable, I acknowledge I have spoken with my child about the importance of abiding by any restrictions placed upon their participation in camp activities.
I authorize Encore/Coda staff, representatives, contractors or other medical personnel to obtain or provide medical care for my child, to transport my child to a medical facility, and to provide treatment (including routine or emergency health care, hospitalization, medications, anesthesia, surgery, sunscreen application) they consider necessary for my child's health. I agree to the release (to or by E/C) of any records necessary for treatment, referral or other purposes. I agree to pay all costs associated with any medical care and transportation.