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Camper Information

First Name

Last name

Age at camp time

Grade entering this fall*

Shirt size

Health Information

Include information about medically significant conditions and doctor prescribed medications in this section. List seasonal Allergies and over the counter medications in the notes section at the bottom.

List any severe or life-threatening allergies, reactions and first response here. Put N/A if none.*

Will camper require medication(s) during camp hours?*

List medications needed, and instructions here. Put N/A if none.*

List any other medical or physical conditions that we should be aware of? Put N/A if none.*

Notes - What else should we be aware of? Put N/A if none.*

Emergency Contact Information

Name*

Phone*

Do you want to register another child?*

Fresh Air Family, Inc.
P.O. Box 130186
Birmingham, AL 35213
205-540-6642
Programs@FreshAirFamily.org

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