Angel Tree Online Registration - Camp Occohannock on the Bay

Form Section

Camper Name

Gender

Date of Birth

Grade0 / 2

Guardian Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Cell Phone

Email Address

Incarcerated Family Member

Relationship to Camper

Last Known Facilitate for Incarcerated Family Member

What you would like us to know about your Angel Tree Camper.

T-Shirt Size

Is this the first time away from home?

Is this the first time at Camp OOTB?

What type of swimmer is your Camper?

What week of camp are you applying for?Descriptions: https://www.ootbay.org/wp-content/uploads/2021/11/Summer-Camp-Brochure.pdf

What would be your 2nd Week option for Camp?Descriptions: https://www.ootbay.org/wp-content/uploads/2021/11/Summer-Camp-Brochure.pdf

Health Form

A PARENT OR GUARDIAN MUST COMPLETE THIS FORM. THE DIRECTORS, HEALTH COORDINATOR AND CAMP COUNSELORS WILL HOLD INFORMATION FROM THIS FORM CONFIDENTIAL. THE INTENT OF THIS FORM IS TO PROVIDE THE CAMP DIRECTOR AND HEALTH COORDINATOR THE INFORMATION NEEDED TO PROVIDE APPROPRIATE EMERGENCY CARE. KEEP A COPY OF THIS FORM FOR YOUR RECORDS. ATTACH ADDITIONAL PAGES OR DESCRIPTIONS AS NEEDED. PROVIDE CHANGES TO THIS FORM TO THE HEALTH COORDINATOR AT CHECK- IN ON THE FIRST DAY OF CAMP.

Health Insurance Company

Group Number / Policy Number / Name of Physician

List Any Known Allergies and Reactions

Physicians Office Phone

Does your child have any Dietary Restrictions?

Medical History

Will you be providing any over the counter medications or prescriptions medications for your camper?

Does your child have any special needs or issues including physical, emotional, health or behavior that the Camp Director should know?

Please describe any special needs or issues including physical, emotional, health or behavior that the Camp director and Staff should know about in advanced:

If there are other Medical Conditions please describe below:

Describe any othe rpast or current injury, illness, disease, treatment, surgery, or affliction the camp should know about in case of emergency.

Church Membership

Church Name

Pastor's Name

Church location or town

How did you hear about OOTB?

Emergency Contact Information

Who do we contact in case of emergency?

Emergency Contact 1

Phone

Email Address

Relation to Camper

Emergency Contact 2

Phone

Email Address

Relation to Camper