Severe Allergy Emergency Information Complete only if your child has a severe allergy Camper's Name * Birth Date * Address Home Phone Today's Date In case of emergency, please contact: Contact 1 Name Home Phone Relationship Work Phone Contact 2 Name Home Phone Relationship Work Phone Family Physician Name Phone Allergies Present Medications Hospital Preference Date of Last Tetanus Booster Blood Type Optional Does your child/ward have any physical, psychological or medical conditions which you feel the Kenilworth Park District should be aware of ahead of time? Optional
