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

1

Read the document

2

Fill in Camper's Full Name

3

Select Camper's Birthday

4

Fill in Camper's Age

5

Fill in Physician's Name

6

Fill in Physician's Phone Number

7

Select Does your camper have asthma?

8

Fill in Please list all of your camper's allergies and their severity.

9

Select Does your camper carry an inhaler?

10

Fill in If your camper carries an Epi-Pen, what allergy is it for?

11

Fill in If your camper has any dietary restrictions, please list them.

12

Select Behavioral/Psychological

13

Select ADHD

14

Select Autism

15

Select Hearing

16

Select Vision

17

Select Bed Wetting

18

Select Outdoor Allergies

19

Select Frequent Headaches/Migraines

20

Select Frequent Upset Stomach

21

Select Fainting or Dizziness

22

Select Diabetes

23

Select Other

24

Fill in Please describe all of the boxes checked above, as well as any other special needs or circumstances. This information helps our camp counselors create the best possible camp experience for your camper!

25

Select For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?

26

Fill in If you answered yes, please list all of the immunizations your camper is exempt from.

27

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