Family Camp Medical Form
Our camp needs medical information to properly identify health care needs of the camper. The Health History (two pages) should be filled out by parents/guardians of minors, or by adults themselves, and the Examination form page must be completed by an appropriate Licensed Medical Person.
BOTH forms must be at camp 2 weeks prior to arrival at camp.
FYI:
In 2003 the State of New Hampshire changed its law on the carrying of inhalers and EpiPen Auto Injectors. If your child, due to health reasons, must carry either of these items, please contact us for the release form you and your physician must sign before your child, by law, can carry these devises. The new laws are online - NH laws: HB0057 and HB0092 or we can send you a copy on request.
Read Safety Regulation Section 485-A:25-b
Read Safety Regulation Section 485-A:25-f
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Mail camp forms to:
Merrimack Valley YMCA
Camping Services Branch
7 Ballard Way
Lawrence, MA 01843
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Form Available Online
For your convenience, we are providing the Family Camp medical form online. Click on the link to view the form and print the form using your printer.
To download the medical form, click here (PDF).
Please Note:
This form is in PDF format, so you must have Adobe Acrobat Reader in order to view it.
