Camper Health Form

Please complete the full form for each camper

In case of an emergency and parent/guardian is unreachable, please notify:

Allergies and Dietary Restrictions


Medications and Treatments


Immunizations:

If you have a copy of your immunization card, you can upload it here.
Click or drag a file to this area to upload.
If you do not have your immunization card please list the date or confirm your camper’s most recent vaccination (if any) or booster is up to date for the following:

Over the Counter Medications:

The following over the counter medications may be given to your camper while at camp. Check all that apply. If there is a preferred or needed name brand, please purchase and check-in as medicine.

Health History

Please check if your camper has experienced, or is currently experiencing, any of the following conditions?

Health Insurance, Physician & Dentist/Orthodontist Information:

Authorization and Release: *a signature is required from a child’s parent or legal guardian

General Release for all campers:
I hereby give permission for the camper and/or myself, as named above, to participate in all camp scheduled activities including sport challenges, zip-lines, swimming, kayaking, and off-site field trips, except as noted. I have read the registration, payment, refund and cancellation information, and agree to the provisions as stated. I have read and agree to the CNJ Privacy Policies found at campnewjourney.org/privacy including permission to use photos of the camper and/or myself in CNJ promotions. The named camper will follow the camp rules and direction of camp staff.
Youth Camper Medical Release:
I hereby give permission for the camper, previously named, to receive the over-the-counter and prescribed medications as indicated at the direction and under the supervision of designated Camp Health Center staff. I hereby give permission to the medical personnel selected by the camp director to provide routine health care; order x-rays, routine tests and treatment; to release any records necessary for insurance purposes; and to arrange necessary transportation for my child. In the event I am unreachable in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for child as named above. This completed form may be photocopied for trips out of camp.
Clear Signature