Rock Lake United Church Camp, Inc. Personal Health Form

Health Form

The online health form is an obligatory portion of the online registration process. Please ensure that it is filled out completely and accurately. Campers must have a valid health form on file prior to attending camp. If you choose paper registration, the health form must be completed within 30 days before camp's start date and brought to camp with your child.

The information on this form will be used at the direction of the camp health care staff to ensure care and attention is given to the health of the participant. All information is considered personal and confidential.

If we are unable to contact the above in case of emergency, please provide an alternate contact below:

Please ensure a parent/guardian completes the remainder of the form.

The waterfront has a designated swimming area that is roped off and supervised by two qualified lifeguards. Does your child require a life jacket to swim in the designated area?
0 of 500 max characters
If female, has the camper menstruated?
If no, is she prepared?
Does the camper wear glasses or contacts?
Does the camper wear medically prescribed ear plugs?
0 of 500 max characters
Please indicate if the camper is currently subject to any of the following
All medication, prescription or over the counter, must be brought to camp in the original container and given to the first aid attendant on arrival. Prescription medication must have a label that indicates camper’s name, name of medication, dose of medication, frequency, physician’s name, and date of prescription.

Medication Information

Add Medication Remove Medication
Please indicate any over-the-counter medications that may be given to your child at camp (if needed).
Acetaminophen (Tylenol)
Ibuprofen (Advil or Motrin)
Gravol (Dimenhydrinate)
Cough Syrup
Antihistamine
0 of 500 max characters

All information supplied to us will help us care for your child in the best way possible while they are at camp. If medical care is required for your child, you will be notified. If your child needs to phone home, they will be asked to phone collect. All medical records are held for seven years, then destroyed.

Do you give permission to use photos and videos of your child in promotional materials for Rock Lake United Church Camp?

Please attach a copy of your Provincial Health Card with both 6 and 9 digit numbers visible:

Maximum file size: 16MB