Summer Camp Medical Form 2021

EVERY CAMPER will need to complete the emergency contact information and completed   Emergency Contact Form.  If there are no medical concerns please type "None".  

Time & Location

GKLL 7/22-7/26 SSLL 8/5- 8/9
5 Tool Baseball, SSLL and GKLL Field Locations

About The Event

EVERY CAMPER will need to complete the emergency contact information and completed   Emergency Contact Form.  If there are no medical concerns please type "None".  If your camper takes medication or uses an inhaler, please bring that with you on day one of the camp.  Place it in a clear bag labeled with the camper's name. Please touch base with a camp counselor on day one to let them know of the medical concern and show them where the camper will be carrying the medication.  

Great Kills Little League

7/22-7/26

South Shore Little League

8/5- 8/9

Typing your name below will serve as your electronic signature and consent. Parent/Guardian Authorization for Health Care: This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me. I understand the information on this form will be shared on a “need to know” basis with camp staff. In the event of a medical emergency, I authorize Johnny D's 5 Tool Baseball to designate a hospital, physician or emergency personnel to provide care (including hospitalization, if necessary) to the child and release Johnny D's 5 Tool Baseball from any liability for injury or harm to the child which may result from this medical care. I understand that responsibility for payment of such care medical will be mine and certify that the child is covered by adequate medical coverage.