Camp Participant Information Form Student Name * First Name Last Name Emergency Contact (other than parent) * First Name Last Name Emergency Contact Phone * (###) ### #### Emergency Contact Relation to Student * Please list any medical conditions or allergies Doctor Information * Name and phone number of primary care physician Food Allergies Please list any food allergies Medications Does your child take any medications during the day that we should be aware of? Does your child have any physical or learning accomodations or needs? Are there any disciplinary concerns that we should be aware of? Photo release consent * By checking the box, you agree to allow Colorado STEM Camps to use your child's image in promotional materials I agree I do not agree Medical Treatment Authorization * By checking the box below, I agree to allow Colorado STEM Camps to seek medical attention in an emergency I agree I do not agree Thank you for filling out the form. If you have any questions, feel free to contact us at info@coloradostemcamps.com