Clear Creek Student Health Information
Camp attendance and health info for students attending clear creek. Please make sure to have your student's Alpine Student Id before filling out this form. If you do not have it please contact your child's school.
Select camp week student is registered to attend
July 30 - August 3
Parent or Legal Guardian Name (Primary Emergency Contact)
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Phone (emergency/important communication)
Emergency Contact and Medical Information
Additional Emergency Contact
Does your child have a health condition that would limit his/her activity at camp?
If yes, please describe health condition
Does your child have required medication(s) you will be sending with him/her to camp?
If yes, list medications by name, dosage and directions
Does your child have food allergies or other special dietary requirements?
If yes, please describe food allergy or special dietary requirements
May the camp staff give Acetaminophen (Tylenol) 325 mg tablet to your child if needed?
May the camp staff give Ibuprofen 200 mg tablet to your child if needed?
May the camp staff give Diphenhydramine HCL (Benadryl) 25 mg tablet to your child if needed?
May the camp give calcium carbonate (Pepto Bismol) 400mg to your child if needed?
May the camp staff treat minor wounds with Neosporin antibiotic ointment for your child if needed?
By selecting "I agree," I attest that I am the custodial parent or legal guardian of the student above and the information is true and correct. I attest that the student's legal residence is within the boundaries of Alpine School District. I agree that the Clear Creek staff may treat my child according to the answers and instructions that have been provided in this form.
By selecting “I agree,” I understand that there will be a $25 fee for cancellations requested more than 48 hours in advance of the 7:00 A.M. camp check-in period on Monday morning. I also understand that there will be no refund for voluntary withdrawal during camp or during the 48 hours preceding the camp check-in period.
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