HOMESICKNESS

If your child becomes homesick, what do you recommend for us to do? ___________________
__________________________________________________________________________

How many times will you allow your child to call home? ________________________________

SWIMMING

What is your child's skill level in swimming? _________________________________________

Are there any special instructions for your child to follow during swim time or water activities?___________________________________________________________________
__________________________________________________________________________

GENERAL INFORMATION

Date of last Tetanus Booster? ___________________________________________________

Does your child have any special fears (storms, animals, loud noises)? _____________________
__________________________________________________________________________

Has there been anything happen in your child's life that will affect him/her emotionally,
such as moving, illness in family, death of family member or pet, or divorce? _________________
__________________________________________________________________________

For the safety and maximum benefit of the Camper, does he/she have any behavior
problems that require close supervision?  Yes___ No ___ If yes, please explain ______________
__________________________________________________________________________
__________________________________________________________________________

Does your Child require a special diet? ____________________________________________
__________________________________________________________________________

PLEASE SUPPLY US COMPLETELY WITH THE FOLLOWING INFORMATION

Family Physician _____________________________________________________________

Family Dentist _______________________________________________________________

Insurance Plan and Number _____________________________________________________

My child may be given Advil or Tylenol if necessary.      Yes            No

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