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Emergency Contact · Popular

Summer Camp Emergency Contact & Medical Alert Form

Easily gather emergency contacts, authorized pickup persons, and medical alert info for every summer camp participant in one secure form.

Use This Template Free Preview

Teal theme

formbuilder.ai/f/summer-camp-participant-emergency-contact-medical-alert-information-form

Summer Camp Participant Emergency Contact & Medical Alert Information Form

Participant's Full Name

· · ·

Date of Birth

· · ·

Age

· · ·

Submit

The Summer Camp Participant Emergency Contact & Medical Alert Information Form helps camp administrators collect all critical safety data before a camper's session begins. It captures participant details, camp session assignments, primary and secondary emergency contacts, authorized pickup persons, and vital medical alert information—all in one organized, easy-to-complete form.

Designed for camp directors, program coordinators, and childcare professionals, this template ensures staff are fully prepared to respond to any emergency. Having accurate, up-to-date contact and medical information on file reduces response time and keeps campers safe throughout their stay.

Using an online form builder to deploy this template makes collection faster, paperless, and accessible for parents to complete from any device before camp begins. Customize fields to match your camp's specific policies, medical protocols, and session structure—no coding required.

3 Pages

23 Questions

~8min To complete

Free No credit card needed

Field types Short Text ×5 Long Text ×5 Full Name ×3 Phone ×2 Date number Single Choice Dropdown Email Multiple Choice termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Participant Information 6 questions

Participant Details

1 Participant's Full Name * Full Name

2 Date of Birth * Date

3 Age * number

4 Gender * Single Choice

Camp Session Information

5 Camp Session * Dropdown

6 Cabin / Group Assignment (if known) Short Text

Page 2 Emergency Contacts 8 questions

Emergency Contacts

Primary Emergency Contact

1 Primary Contact Full Name * Full Name

2 Relationship to Participant * Short Text

3 Primary Contact Phone Number * Phone

4 Primary Contact Email Address * Email

Secondary Emergency Contact

5 Secondary Contact Full Name * Full Name

6 Relationship to Participant * Short Text

7 Secondary Contact Phone Number * Phone

Authorized Pickup Persons

8 List any additional persons authorized to pick up your child (include full name, relationship, and phone number for each) Long Text

Page 3 Medical & Health Information 9 questions

Medical Alert Information

1 Known Allergies (food, medications, insect stings, environmental — please list all and describe severity) * Long Text

2 Current Medications (include name, dosage, and frequency) Long Text

3 Chronic Conditions or Ongoing Medical Concerns (e.g., asthma, diabetes, seizures, heart condition) Long Text

4 Does the participant carry any of the following? * Multiple Choice

5 Primary Care Physician Name & Phone Number * Short Text

6 Health Insurance Provider & Policy Number * Short Text

7 Additional Notes or Special Instructions for Camp Staff Long Text

8 I confirm that the information provided is accurate and complete. I authorize camp staff to administer first aid and seek emergency medical treatment for my child if I cannot be reached. * termsandconditions

9 Parent/Guardian Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.