Medical Information Form

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Incase of emergency, what is the best number to get ahold of you?

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Emergency Contact Information: In the case of an emergency, we will first attempt to contact the parents/guardians. If they cannot be reached, the camp will contact the below authorized emergency contact. If I choose not to provide an emergency contact, I realize that if parents/guardians cannot be reached, ETC will not have a person selected by myself to contact.

Please list any other adult (other than parents/guardians listed above – both automatically have pickup authorization), who is allowed to pick-up the child from camp (including emergency contact.):  This field is required, if you have no additional authorized contacts, please enter N/A below.

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Medical/Health Information: If child has medical concerns or allergies, please make sure to fill in all pertinent information below: (all fields are required, if no information is available, please enter N/A)

Pre/Post Care: Ensemble Theatre Company, Ltd does not provide pre/post care opportunities at this time. Please do not drop child off more than 15 minutes before the start of camp (9:00 am) in the morning. In the afternoon a pickup grace period of 15 minutes is allowed. After that grace period (4:15 pm) there will be a charge of $1.00 per minute, non-emergency related.

I certify that all of the above information is correct and accurate to the best of my knowledge. I understand and agree to the policies of Ensemble Theatre Company, Ltd.

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