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Camp Physician s Insurability Form (Attachment to Form 6011 -Camp Physician s Program Application) EXPLANATION The purpose of this form is to secure information that can attest to your insurability

How to fill out camp physician39s insurability form

Who needs camp physician's insurability form?

1. Camp organizers: Camp organizers may require all participants, including campers, staff members, and volunteers, to fill out the camp physician's insurability form. This form ensures that everyone participating in the camp is medically fit, has proper insurance coverage, and can receive necessary medical treatment if needed.
2. Parents/Guardians: If you are a parent or guardian of a camper, the camp physician's insurability form will typically be necessary for you to complete. This form allows the camp organizers to have detailed information about your child's medical history, allergies, medications, and insurance coverage. By filling out this form, you help ensure your child's safety during their camp experience.
3. Campers: In some cases, especially for older campers or those attending specialty camps, campers may be required to fill out their own camp physician's insurability form. This allows the camp medical staff to have direct information from the campers themselves about their medical conditions, allergies, medications, and any necessary insurance coverage.

How to fill out camp physician's insurability form:

1. Provide personal information: Start by filling out your name, date of birth, address, and emergency contact information on the form. This ensures that camp organizers and medical staff can easily identify and reach you or your child in case of an emergency.
2. Medical history: Answer the questions related to medical history thoroughly and honestly. Provide details about any pre-existing conditions, allergies, or chronic illnesses that may require special attention or medication during the camp. It is important to accurately disclose any medical conditions to ensure appropriate care and a safe camp experience.
3. Medications: If you or your child is currently taking any medications, list them on the form along with the dosage and frequency. This information helps the camp medical staff keep track of any necessary medications and ensure they are administrated correctly.
4. Insurance information: Provide details about your or your child's health insurance coverage. Include the insurance company's name, policy number, and contact information. This ensures that if any medical treatment is required during the camp, the medical staff can contact the insurance company for coverage information and billing purposes.
5. Emergency contact: In case of a medical emergency, provide the contact information for a trusted individual who can be reached quickly. This could be a parent, guardian, or another family member who can make decisions on your or your child's behalf.
6. Signature and consent: Finally, review the form carefully, making sure all information provided is accurate. Sign and date the form to indicate your consent for the camp medical staff to access and use the provided information for medical purposes during the camp.

By following these steps and accurately completing the camp physician's insurability form, you can help ensure a safe and well-prepared camp experience for yourself or your child.

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