Camp Wamp Physical Evaluation Form

Parent / Legal Guardian Contact Information:

To Physicians and Their Staff:

This person is a camper at Camp Wamp. The job includes physical activity such as lifting, hiking, and canoeing, and requires the individual to be outside in a variety of weather conditions. Our staff use the information provided on this form to guide their interface with the camper. If you question the person’s suitability for their participation, please talk with them and/or their parent/guardian about your concerns and develop a plan to address that concern. You can also speak to one of our camp professionals by calling 530.721.6369. Thank you!

Camper Information:


The following medications are stocked in our Health Center and will be used to manage illness and/or injury.
CHECK any that are contraindicated for this person.

Note: We expect the person will have an EpiPen and know how to use it if anaphylaxis is a known reaction.

Doctor's Signature

By signing this form, you are stating that, in your opinion, this person is both physically and emotionally ready to participate at our camp except as noted in your comments. To sign this form, click the "Submit" button and create a verified E-signature on the next page.