Bristol Academy of Music

Summer Camp Medical Form

Please complete the form below before dropping your child off with us!

Student Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Emergency Contacts

Please list 2 names, relationships to camper, and phone numbers

Allergies

Does the Camper have any allergies or dietary restrictions? If so, please list below:

Medical History

Does the camper have any medical restrictions or accommodations that we need to be aware of?

Bristol Academy of Music reserves the right to use photos and videos of students for marketing purposes.