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

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 5 types of camps listed below.

Holiday Camps

March Break Camp

PA Day Adventures

PA Day Experiences

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 issues 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

Does your child require medication (including inhalers and auto-injectors)?

Yes