Medium

Available on

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Camping Health Consent and Release Form Mobile App

Information in this app is protected by HIPAA privacy laws and should be handled accordingly. GoCanvas Apps can easily be made HIPAA Compliant. The Camping Health Consent and Release Form mobile app is only good for travel to and from, and attendance at, a specific camp; it should not be used for any other camping trip. The app should be completed for each camp experience. The camp experience should be a safe and healthy one. However, in the event of an accident or illness, it is important that camps have the following information: Medical history; Medical insurance information; and Proof of physical examination, verified by Physician’s signature, required for ALL guests attending camps. Pregnant and Post-Delivery Teens: Pregnant teens up to 34 weeks and teen moms 6 to 12 weeks post-delivery on camp date must have a physician’s release. Teen moms less than 6 weeks post-delivery on camp date may not attend. Pregnant teens over 34 weeks to full term are not allowed to attend camp. Pregnant teens over 30 weeks may not attend remote/ rural camps.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Camping Health Consent and Release Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Email

  • Ico textbox

    Name

  • Ico date

    Birthdate

  • Ico dropdown

    Sex

  • Ico integer

    Age

  • Ico textbox

    Parent or Guardian (or spouse)

  • Ico textbox

    Cell Phone

  • Ico multiline

    Home Address

  • Ico textbox

    Home Phone

  • Ico multiline

    Business Address

  • Ico textbox

    Phone

  • Ico textbox

    Second Parent or Guardian Emergency Contact

  • Ico multiline

    Home Address

  • Ico textbox

    Home Phone

  • Ico multiline

    Business Address

  • Ico textbox

    Phone

  • Ico textbox

    If not available in an emergency, notify: Name

  • Ico multiline

    Home Address

  • Ico textbox

    Home Phone

  • Ico textbox

    Name of School Camper Attends

  • Ico statictext

    I understand that my personal insurance will be primary coverage for camper accidents and that Yo...

  • Ico textbox

    My insurance company

  • Ico textbox

    Policy Number

  • Ico multiline

    Insurance company address

  • Ico statictext

    Not currently insured - reserves the right to subrogation if it is later determined that personal...

  • Ico checkbox

    Not currently insured - reserves the right to subrogation if it is later determined that personal...

  • Ico statictext

    Health Care Recommendations: A physician’s signature must be on file at time of registration for ...

  • Ico dropdown

    ) Does applicant have a medical condition such as sickle cell or respiratory or other ailment or ...

  • ...and More!

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