2025 Camper Health Form

You can choose to submit a digital health form the week before camp for each camper OR you can bring a paper copy to camp with you.

Campers will need to check-in with the nursing team at registration to ensure there are no qeustions about their health form or medications.

Campers with medication will need to bring their medications in their original containers in a Ziploc Bag (large enough so that it can still zip shut) with the campers name legibly printed on it.

Paper copies can be printed at: https://sgu.camp/forms/

Please complete this form as the CAMPER.

Your name *

Last name

Email address *

Birthdate

Gender

Phone number

Phone type

Address

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Parent/Guardian Info

Camper Resides with: *

Both Parents

Mother

Father

Other

Parent/Guardian (A) Name *

Parent/Guardian (A) Cell Phone *

Parent/Guardian (A) Alternate Phone *

Parent/Guardian (B) Name

Parent/Guardian (B) Cell Phone

Parent/Guardian (B) Alternate Phone

Insurance Information

Insurance Information is helpful should there be a medical emergency.

Insurance Company Name

Policy Number

Group Number

Policy Holder Name

Policy Holder Date of Birth

Relationship to Camper

Camper Health Info:

Allergies

Does the camper have allergies? If so, please list out here.
Common items include are: Bee stings, foods, medications, seasonal allergens, etc.

Does the camper have (or have they had) any of the following conditions? *

Asthma

Seizures

Fainting

Sleep Walking

Hearing Impaired

Vision Impaired

Back Pain

Heart Conditions

Chronic Illness

Diabetes

Psychological Disorder

NONE

Other

What is the best way to treat anything checked above?

List current medications. *

Include Name, Dose & Frequency
If no meds, say "NONE"

List any conditions that may restrict activities & indicate how to best accommodate.

Emergency Contact Info

Should Parent/Guardian (A) & (B) Above not be available, who would you like us to contact?

First & Last Name *

Relationship to Camper *

Primary Number *

Include Area Code

Secondary Number

Include Area Code

Camp Departure

Camp departure is scheduled for Noon on the Friday of camp.
Families are responsible for securing their own transportation to/from camp.

Who will your camper be riding home with? *

(Parent, Sibling, Church, Other person?)

Participation Permission/Consent

The undersigned represents that he/she is the custodial parent/legal guardian of the identified participant. The camper has my permission to attend the Summer Games/SGUcamp 2024 July 8-12, 2024 This permission is given by me with full knowledge of the conditions and activities contemplated during each session. The participant has no physical or mental disabilities that would impair their participation except as noted above. I will not hold the camp or camp personnel liable for injuries suffered as a result of the campers own voluntary actions.
I give permission and consent for my camper to participate in all activities and to allow photographs, videotapes, and interviews to be taken during the camp session and to be published and used to illustrate, report, promote, and advertise the camp. Use of any such photographs, videotapes, or interviews may include, but are not limited to, use in websites, catalogues, brochures, flyers, and general promotional materials.
I give my consent for my camper to receive over-the-counter medications for common ailments, such as Tylenol, hydrocortisone cream, etc.
I understand that Summer Games is not responsible for lost, stolen or damaged personal items and that my camper is responsible for the safe-keeping and protection of personal items at all times.
I understand that camp insurance is an accident policy, not a medical illness policy, and is a supplemental policy only. It will pay whatever my own insurance does not cover (deductible or over) up to the limit of the policy. If medical (sickness, injury) care is needed, billings will be sent to the parent-guardian who will be responsible for direct payments to physician, hospital, clinic, etc.
The participant is currently taking only medications listed on this form. The camper has no allergies known to me except those noted on this form. The health history is correct as far as I know.
In the event of illness or injury, I authorize the physician and/or hospital to undertake such treatment of and perform such services (including surgical) for the participant as are reasonably indicated by the circumstances.

I acknowledge the above consents & give permission. *

Parent/Guardian Signature *

Type your name to indicate acceptance of the acknowledgment.

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SGU Camp
info@sgu.camp
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