Medical Information Form



Lives in Household with Child


Lives in Household with Child

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


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.


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)

Medical concerns or allergies of child

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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Required Forms

The following forms must be completed. Please click to fill out the form online or download, print, sign and send with your child on the first day of camp.

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