Health Form

WCFA Health & Emergency Contact Form

Camper families must complete this form prior to the first day of camp.

Student/Camper Information

Student/Camper's Name(Required)
At time of first day of camp/class
ex: she/her. they/them, he/him, etc.
Student's Gender Identity
Student's ethnicity
We ask for this optional demographic information in order to provide data for our funding/grant applications.
What is your annual average household income?
Additional Participant Information:
Please also use this space to explain any other physical, mental, emotional or social health situations that staff should be aware of to ensure this child has the best possible experience at camp/class.
ex: 5 Maple Lane, Warwick, RI 02886
Parent or Guardian's Email(Required)
Pick Up Authorization
ex: Cedar Hill Elementary, Warwick
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