MEMORIAL DAY CAMP REGISTRATION
Step #1

Youth Camp Health History Form

Camper's Name(Required)

First Last

Parent or Legal Guardian Email(Required)

Current residence(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

EMERGENCY CONTACT INFORMATION

Emergency Contact Person(Required)

First Last

Emergency Contact Phone(Required)

Primary Care Physician or other provider of medical care(Required)

First Last

HEALTH INFORMATION

Are there any pertinent health problems including physical, psychiatric, or behavioral problems of which we need to be aware?(Required)

YES, and I have discussed employment/volunteering at camp with my healthcare provider including considerations related to risk of COVID-19

Explain health problems and any considerations:

Are there any medications, dietary restrictions, allergies, or special needs of which we need to be aware?(Required)

YES

Please explain any medications, dietary restrictions, allergies, or special needs of which we need to be aware?

A separate medication form will be emailed to you upon submitting your camp registration. Please fill that out and send it back to us.

IMMUNIZATION INFORMATION

Do you currently reside within the United States, a United States territory, or the District of Columbia?(Required)

YES

Do you have any immunization exemptions because of a parental or guardian objection or medical contraindication?

YES

Please list any immunization exemptions:

For campers who reside outside the United States, a United States territory, or the District of Columbia:

Please fill out and email us a record of vaccination or immunity on Department form MDH-896. This form will be emailed to you upon submitting this form.

SIGNATURE

Your Legal Name(Required)

First Last

Camper Signature or Parent or Legal Guardian’s Signature:(Required)

(If Camper is Under 18 Years)

Reset

Date of signature(Required)

Submit and continue to Step #2

HOW TO:

✅ Here’s how to properly enroll your child in Memorial Day Camp and secure a spot:

Step #1: Complete & sign our health form.
Step #2: Complete & sign our camper form.
Step #3: 💳 Make a payment.

📎You’ll be emailed a confirmation of both forms after completion.

Visit Us:

13220 Long Green Pike,
Hydes, MD 21082

Have a Question? Call us

(443) 606-4639

E-mail: hhfarm2012@gmail.com

MEMORIAL DAY CAMP REGISTRATION Step #1

Youth Camp Health History Form

EMERGENCY CONTACT INFORMATION

HEALTH INFORMATION

IMMUNIZATION INFORMATION

For campers who reside outside the United States, a United States territory, or the District of Columbia:

SIGNATURE

Submit and continue to Step #2

HOW TO:

✅ Here’s how to properly enroll your child in Memorial Day Camp and secure a spot:

MEMORIAL DAY CAMP REGISTRATION
Step #1