SixTwelve Medical Release Form

Name of Student/Camper *
Name of Student/Camper
Birth Date of Student/Camper *
Birth Date of Student/Camper
Guardian of Camper *
Guardian of Camper
Please Check any allergies your student/camper may have: *
If none, please write "none" here.
Does your child have asthma? *
Please enter your name in this box, acting as an electronic signature.
Today's Date *
Today's Date
Please enter today's date in the following field, dating this document.