Centaur Summer Camp Health Registration

Health Registration for Centaur Summer Camps at The Woodstock Academy

August 5-9 & August 12-16, 2024
Complete this form after you have registered for a Centaur summer camp.
Camper Information
Name*

First NameLast Name
Select the camps your student is registered for (A separate form is required for basketball camp)*

Arts ExplorationBasketballCSI ForensicsCulinary ArtsDanceTable Top GamesMakerspace
Date of Birth*

MonthDayYear
Date
Contact Information
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Primary Phone Number*

Area CodePhone Number
Parent/Guardian Secondary Phone Number*

Area CodePhone Number
Alternate Emergency Contact*

First NameLast Name
Alternate Emergency Contact Primary Phone Number*

Area CodePhone Number
Alternate Emergency Contact Secondary Phone Number

Area CodePhone Number
Medical Information

and Emergency Consent
Does your child have allergies?*

yesno
Do your child have a bee sting allergy?*

yesno
Do your child have asthma or use an inhaler?*

yesno
Do your child have any heath concerns that will require a consult with a nurse?*

yesno
Does your child need medications while at camp?*

yesno
If yes to any of the above, please explain:
Is there any additional health or medical information that we should be aware of?
Date of Last Physical/Tetanus Vaccine*

MonthDayYear
Date
Authorization to administer medication

If the camper will need medication administered during camp hours, please complete the Authorization for the Administration of Medication by School, Child Care, and Youth Camp Personnel form.

Download the form on our Centaur Summer Camps page. The form can be attached here or emailed to bsaucier@woodstockacademy.org before the beginning of the camp.
Upload the Authorization to Administer Medication form

Browse Files
Only if your camper requires medication to be administered at camp. Cancelof
Emergency Medical Consent:

I affirm that the information above is complete and that my son/daughter is in good health to participate in The Woodstock Academy Summer Academic Camps. I understand that it is the parent’s responsibility to notify the Nurse/Camp Director of any health concerns or needs of my child during the camp. In addition, by signing below I give permission for The Woodstock Academy medical staff to treat my child and/or transport to the nearest medical facility if an emergency arises and the emergency contact is not able to be reached.
Name*

First NameLast Name
Signature*

Clear
Should be Empty:

Health Registration for Centaur Summer Camps at The Woodstock Academy

Camper Information

Contact Information

Medical Information