Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

GIRL GUIDE ASSOCIATION OF JAMAICA CAMPIP ACK HOLIDAY FORM

NAl\1E: ADDRESS: ..PHONE NO.: RELIGION: I GIVE PERMISSION FOR MY DAUGHTER" CAMPIPACKHOLIDAY AT FROM '" AGE '" ., . . . "' ..TO ATTEND TO . . .

DATE OF BIRTH:

MY ADDRESS WHILE SHE IS AT CAMPIP ACK HOLIDAY WILL BE ... ................................................. ................................................................. SIGNED: PARENT/GUARDIAN AND THE PHONE NUMBERS TO CONTACT ARE IN CASE OF EMERGENCY PLEASE CONTACT
~

TELEPHONE

************************************************************************

HEALTH FORM
DOES YOUR CHILD SUFFER FROM ANY ALLERGY OR PARTICULAR AILMENT? ~. IF SO, WHAT MEDICATION IS REQUIRED? IS SHE ALLERGIC TO ANY FOOD? " . _

IS THERE ANYTHING WHICH SHE CANNOT, OR FOR RELIGIOUS REASONS, MAY NOT EAT? DOES HER HEALTH REQUIRE ANY SPECIAL CARE OR ATTENTION? CAN SHE SWIM? MAY SHE SWIM IN THE SEA? DOES SHE GET CAR SICK? HOW WELL? IN THE RIVER? IN APOOL? . . . . . PARENT/GUARDIAN .. .. " . . .

IF SO, WHAT DOES SHE TAKE?

DOES SHE REACT VIOLENTLY TO WASP OR BEE STINGS? ANY OTHER COM:MENTS? SIGNED:

ALL MEDICAnON MUSTBE HANDED IN TO THE GUIDER IN CHARGE OF HEALTB AND SANITATION AND WILL BE DISPENSED AS REQUIRED. SWIMMING ,warE BE CONDUCTED UNDER STRICT SUPERVISION OF A QUALIFIED LIFE GUARD

You might also like