SayPro Health and Safety Form for the 5 Days Faith-Based Camp.

SayPro Health and Safety Form

Welcome to the SayPro 5-Day Faith-Based Camp registration process! The health and safety of our participants is our top priority. Please complete this form to provide essential health-related information, including any allergies, medications, medical conditions, and emergency contacts. This information will help us ensure that your child’s camp experience is both safe and enjoyable.

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Participant Information

1. Full Name of Participant:
   [Text Field]
2. Date of Birth:
   [Date Picker]
3. Age:
   [Dropdown Menu: 5-12 years, 13-17 years, 18+ years]
4. Gender:
   [Dropdown Menu: Male, Female, Non-binary, Prefer not to say]
5. Parent/Guardian Full Name:
   [Text Field]
6. Phone Number (Parent/Guardian):
   [Text Field]
7. Email Address (Parent/Guardian):
   [Text Field]

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Emergency Contact Information

Please provide an emergency contact person who can be reached in case of an urgent situation during the camp.

1. Emergency Contact Name:
   [Text Field]
2. Relationship to Participant:
   [Text Field]
3. Emergency Contact Phone Number:
   [Text Field]
4. Secondary Emergency Contact Name:
   [Text Field]
5. Secondary Emergency Contact Phone Number:
   [Text Field]

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Medical Information

Please provide detailed information regarding your child’s medical history to ensure we can offer the best care during the camp.

1. Does your child have any known medical conditions?
   [Dropdown Menu: Yes, No]
   If yes, please list them below:
   [Text Field]
2. Does your child have any allergies?
   [Dropdown Menu: Yes, No]
   If yes, please specify the type(s) of allergy (e.g., food, insect stings, environmental, medication, etc.) and symptoms:
   [Text Field]
3. Does your child have a history of asthma or breathing issues?
   [Dropdown Menu: Yes, No]
   If yes, please provide details:
   [Text Field]
4. Does your child have any other chronic conditions (e.g., diabetes, seizures, heart conditions, etc.)?
   [Dropdown Menu: Yes, No]
   If yes, please provide details:
   [Text Field]
5. Does your child have any mobility or physical restrictions?
   [Dropdown Menu: Yes, No]
   If yes, please specify:
   [Text Field]
6. Is your child on any medications?
   [Dropdown Menu: Yes, No]
   If yes, please list the medications, dosages, and the times they should be administered:
   [Text Field]
7. Does your child need assistance with administering medication?
   [Dropdown Menu: Yes, No]
   If yes, please explain the assistance required:
   [Text Field]

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Dietary Restrictions or Special Needs

Please provide information regarding your child’s dietary needs and any special accommodations they may require.

1. Does your child have any dietary restrictions (e.g., vegetarian, vegan, gluten-free, halal, kosher)?
   [Dropdown Menu: Yes, No]
   If yes, please provide details:
   [Text Field]
2. Does your child have any food allergies or sensitivities?
   [Dropdown Menu: Yes, No]
   If yes, please provide details:
   [Text Field]
3. Does your child require special accommodations or assistance due to health needs?
   [Dropdown Menu: Yes, No]
   If yes, please specify:
   [Text Field]

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Health Insurance Information

Please provide details of your child’s health insurance coverage for emergency situations.

1. Health Insurance Provider:
   [Text Field]
2. Policy Number:
   [Text Field]
3. Insurance Group Number (if applicable):
   [Text Field]
4. Policy Holder’s Name:
   [Text Field]
5. Primary Care Physician Name and Phone Number:
   [Text Field]

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Health and Safety Consent

Please review and confirm the following:

1. Medical Treatment Consent:
   By checking this box, I authorize the camp staff to seek emergency medical treatment for my child if necessary, including transportation to the nearest medical facility if required. I agree to assume responsibility for any medical costs incurred.
   [Checkbox: I agree]
2. Health History and Medication Accuracy:
   By checking this box, I confirm that the medical history, allergy, and medication information provided in this form is accurate and up to date. I understand that it is my responsibility to update the camp if there are any changes to my child’s health status prior to the event.
   [Checkbox: I agree]
3. Liability Waiver:
   By checking this box, I release SayPro, its staff, and volunteers from any liability in case of accident, injury, or illness that may occur during the camp, except in the case of gross negligence or intentional harm.
   [Checkbox: I agree]
4. Photo/Video Release:
   By checking this box, I grant permission for my child’s photo or video to be used in promotional materials, such as brochures, website content, or social media, to promote SayPro’s programs.
   [Checkbox: I agree]
   [Checkbox: I do not agree]
5. Participant’s Code of Conduct Agreement:
   By checking this box, I agree that my child will adhere to the camp’s code of conduct, including respect for other participants, staff, and the camp’s values.
   [Checkbox: I agree]

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Submit Your Health and Safety Form

Please review all the information provided, and once complete, click “Submit” to finalize your child’s registration for the 5-Day Faith-Based Camp. If you have any questions, please do not hesitate to contact us at [Insert Contact Email or Phone Number].

[Submit Button]

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Thank You for Completing the Health and Safety Form!

We appreciate your cooperation in ensuring your child’s safety and well-being at the 5-Day Faith-Based Camp. We look forward to a memorable and enriching experience!

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This Health and Safety Form collects all essential medical, dietary, and emergency information necessary for the camp, helping staff prepare to address any special needs, provide appropriate care, and ensure a safe and positive environment for all participants.