R4, 2021-09-02

NOTE: Terrapin Adventures does not accept paper waivers, please submit electronically.

Youth Program Health Form

Please list a number that could be contacted in an emergency.

Make sure this is a number that can be reached in the event of an emergency.

Don't forget to include emergency medications such as epi pens or inhalers.

If none, write none.




 


Please Check off any of the below conditions that apply to the Camper, regardless of severity.

Chrons, Irritable Bowel Syndrome, Chronic Constipation, etc


 

Children that reside outside the United States, a United States Territory, or the District of Columbia: You must submit a record of immunization or immunity to the Youth Program's Manager via email at Campdirector@terrapinadventures.com

Click to Sign
I confirm that the information given in this form is true, complete and accurate at the time of submission. I will submit a new form if any health information changes.