Camps and Workshops Health Form

Please fill out the Health Form below. 

Student Information
Parent/Guardian 1 Information
Parent/Guardian 2 Information
Doctor Information
Emergency Contact #1
Person to call in case of an emergency and parent/guardian is unable to be contacted
Health Information

Please list any type of allergies, medications, asthma, diabetes, epilepsy, seizures, etc. Please put N/A if there are no concerns.

I hereby authorize my child to participate in the Lawrence Academy of Music summer camp.  In the event that I cannot be reached in an emergency, Lawrence has my permission to arrange care and transport for my child to a health care facility/physician.
 
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The institution will comply with Title VI of the Civil Rights Act and DPI's Nondiscrimination Provision for all students.

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