Health Form | Camp Eden Woods

Camper Health Form

Please take a moment to fill out this health form for each camper.

Camper's Full Name

Camper's Home Address ( Street # and Name)

Camper email

1st Parent/Guardian Name

2nd Parent/Guardian Name

1st Emergency Contact Name

2nd Emergency Contact Name

Camper's Date of Birth

City

Province/State

Postal/ZIP code

School Name

Last Grade Completed as of July 1st 2024

1st Parent/Guardian Email

1st Parent/Guardian Phone Number

2nd Parent/Guardian Email

2nd Parent/Guardian Phone Number

Visitation Rights and Custody

Upload Custody Documents URL file (google forms link is easiest)

1st Emergency Contact Relation

1st Emergency Contact Email

1st Emergency Contact Phone

2nd Emergency Contact Relation

2nd Emergency Contact Email

2nd Emergency Contact Phone

Cabin Request. Who would your child like to be grouped with?

Please list all of your child's allergies (Please fill out a severe allergy form if this is applicable)

Please list any chronic or recurring illnesses or medical conditions

Does your child have and physical or sensory facility needs?

During the past year, has your child seen a professional to discuss mental or emotional health concerns?

Please list your child's dietary restrictions and food sensitivities

Please list all medication your child is current taking (and send us instructions)

Has your child ever been treated for emotional or behavioural challenges or disordered eating?

Has your child experienced a signifigant life event (new sibling, death of a loved one, family change, survived a traumatic event, etc..)?

We want to support our campers and staff to the best of our ability. Is there anything else not covered on the form that will allow us to best support your child?

Family Physician Name

Dentist Name

OHIP number (Ontario Residents)

Health Insurance Carrier Name

Family Physician Phone Number

Dentist Phone Number

Travel Insurance (International Campers)

Health Insurance Policy Number

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