OLD PATHS CAMP 2020 CAMPER REGISTRATION Do not bring medications to the church. If your camper becomes ill or in need of medical attention you will be notified and arrangements will be made for you to pick up your camper or meet at designated emergency facility. OK Question Title * 1. CAMPER INFORMATION Campers Name: Age: Address/City/State/Zip Emergency Contact Name and Number: OK Question Title * 2. List any allergies that the camper has to food or medications: Food: Medications: OK Question Title * 3. List any medical conditions/problems that camper has been diagnosed with: OK Question Title * 4. Has the camper been within 6 feet of a person with confirmed corona virus (COVID 19) in the last 14 days? Yes No OK Question Title * 5. In the last 48 hours has the camper had any of the following symptoms?Fever of 100 or greater?CoughTrouble breathingChillsMuscle AchesSore throatLoss of taste or smellNausea, vomiting, or diarrheaHeadacheIF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE SYMPTOMS. PLEASE, DO NOT BRING THE CAMPER FOR ACTIVITIES OR CHURCH. SEEK MEDICAL ATTENTION FROM YOUR FAMILY PHYSICIAN. Yes No OK DONE