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Summer Music + Arts Camp Medical Information

  • Name as it appears on your insurance card.
  • Medication nameDoseWhen taken 
    Add a new row
    All medicine(s) need to be properly labeled in original pharmacy container. Over the counter medication must also have the youth’s name written on the container.
  • + Add another child   + Remove child
  • I certify that by typing my name above in the Electronic Signature Field and submitting this form, I intend to sign this document and be bound to the same extent as if I had provided a physical signature.