HEALTH & EMERGENCY CONTACT FOR CAMPERS

This form must be completed for EACH CHILD and submitted before June 1st 2012. It DOES NOT need to be completed by a physician. Important: If camper is 6 years of age or under, Dade County Department of Health requires us to have a PHYSICIAN SIGNED copy of current (within one year of 5/29/2011) Certificate of Good Health (HRS Form 3040), Fla. Cert. Of Immunization, Inc., a TB test (HRS Form 680)

CAMPER'S INFORMATION