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Spartans Summer Sports Camp Health Questionnaire

 Child’s Name: _________________________            Age: _____                              Date of Birth: ___________

 Emergency Contact Name: ________________           Relationship: _________   Phone Number: _______________

 Cell Phone: _______________                        Work Phone: _______________          Additional Phone: _______________

1.       Is your child allergic to any medication?                                                                    Yes      No

2.       Is your child taking any medication?                                                                          Yes      No

3.       Is your child currently under a doctor’s care?                                                            Yes      No

4.       Are there any physical or mental conditions we should be aware of?                          Yes      No

5.       Do you state your child is in good mental and physical condition and can                                            

       participate in all camp activities?                                                                              Yes      No

6.       Do you give The Spartans Camp and it’s Directors and Employees

the permission to act in your child’s best interest during your absence if

medical attention is required?                                                                                   Yes      No

Please explain any “Yes” answers to questions 1 – 4 in the space provided below.  Use reverse side if more space is needed.

 The Health Department Requires the following information:

 Vaccine                                                                                    Date of Immunization

I agree not to hold the Spartans Camp, Metropolitan Sports Camp, Inc., it’s Directors and Employees responsible for any liability during the camp activities.  I understand that physical activities will take place and I give permission for my child to participate.  I also give permission for me child to be transported to local fields and or batting cages depending on weather or other circumstances.  I am aware that there are no cash refunds given for any reason including my deposit.  Deposits and tuition are not transferable to other camp sessions.  I understand that any camper not following the rules set forth by the camp may be removed without any recourse and without any refund of money deposited.

Parent / Guardian Signature: ________________________                              Date: ________________