Required fields are marked with asterisks (*)

Medical Information Form - Camps

The Town of Milton Community Services Department endeavours to provide a safe and enjoyable environment for everyone. If your child requires medication while attending a camp program, or if they have an allergy, please read this form carefully.

For returning campers, this online form consolidates and replaces the following 4 forms for a single participant:

Medication Consent Form
Participant Asthma Form
Participant Allergy Form
Anaphylaxis Emergency Plan Form

Personal information contained on this form is collected under the authority of the Municipal Act, 2000 and will be used in assessing and treating participant allergies, anaphylaxis and asthma and/or dispensing required medication.. Questions about this collection should be directed to Coordinator, Recreation 905-878-7252 x2613

Participant Information

Participant First Name:

Participant Last Name

Date of Birth

Street Address:

Town

Postal Code:

Camp Information

Please help us to direct your submission to the appropriate camp councillor by telling us which camp(s) your child will be attending.

Choose from the summer camp options listed below.

Parent/Guardian Contact Information

Parent/Guardian #1 First Name:

Parent/Guardian #1 Last Name:

Email Address:

Phone #1:

Phone #2:

Parent/Guardian #2 First Name:

Parent/Guardian #2 Last Name:

Email Address:

Phone #1:

Phone #2:

Emergency Contact

Emergency Contact Name:

Emergency Contact Last Name:

Emergency Contact Relationship

Phone #1:

Phone #2:

Allergies (including Anaphylaxis), Asthma and Medication

Please indicate any of the following that affect your child. Your choices will prompt additional questions regarding your child's medical condition and medications.

Does your child experience asthma?

Yes

Does your child experience allergies (including anaphylaxis)?

Yes

Form Builder

Medical Information Form - Camps

Participant Information

Camp Information

Parent/Guardian Contact Information

Emergency Contact

Allergies (including Anaphylaxis), Asthma and Medication