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Camp Webegee Medical Form

  1. PLEASE FILL OUT THIS FORM COMPLETELY

  2. Session (check all that apply)*

  3. Sex:*

  4. Does the camper have any allergies? *

    If yes, list below:

  5. Is the camper taking any medication? *

    If yes, list below:

  6. Should the physical activity of the child be restricted for medical reasons?*

    If yes, list below

  7. Does your child have an Individualized Education Program (I.E.P.) provided by their school?*

    If yes, please contact Mary Furfaro, Coordinator of Inclusive Services, at (314) 505-8607.

  8. Are you or your child in need of any special accommodations/assistance needs in order to successfully participate in our programs (e.g. an interpreter, etc.)?*

    If yes, please list below:

  9. What is the level of your child’s swimming ability?*

  10. Please type your First and Last name

  11. Please type your First and Last name

  12. I hereby consent and authorize Webster Groves Parks and Recreation Department, the sponsor of this camp, to reproduce photographs or video taken of my child for advertising and publicity purposes of every description (such as in our program brochure). *

    If yes, please sign below

  13. Please type your First and Last name

  14. My child has permission to walk to and from camp*

  15. My camper has permission to ride their bicycle to and from camp*

  16. My camper has permission to stay at the W.G. Aquatic Center on pool days (after Webegee exits the pool)*

  17. If you checked “yes” to stay at the pool, please indicate a day(s)

  18. Leave This Blank:

  19. This field is not part of the form submission.