cSw Emergency Contact/Medical Information

Every effort is taken to ensure your child's safety and well being. However, in case unforeseen circumstances arise, please provide the best emergency contact and any other pertinent details that may be of assistance during the cSw Boot-Camp.
Student Name*
First Last
Emergency Contact*
In case of an emergency please contact:
First Last
Emergency contact phone number*
Emergency contact home address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Medical Information and Parent/Legal Guardian Emergency Contact Authorization
Medical Information*
List any SEVERE allergies (bee stings, foods, etc.) that cSw staff should be aware of.
Medications or major health concerns.
Please list any medications or major health concerns that might affect your child's participation in the cSw Boot-Camp.
Emergency Waiver*
In case of emergency I agreed that cSw staff may first call 911 and then contact the child's emergency contact listed above.
- Yes
- No

Medical Information and Parent/Legal Guardian Emergency Contact Authorization