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Golf 2025

Apple Ridge Farm

About
- Overview
- History
- Team & Board
- Contact Info
- Pricing
- Jobs
Programs
Outdoor Adventure
Facility Rentals
Weddings
Donate
- Donate Online
Payment
Golf 2025

Summer Camp Health Form 2026

Please complete the form below FOR EACH child that you have attending Apple Ridge this summer! If we do not have you completed health forms for each child they will not receive a bus pass and will not be allowed on the bus day 1. If you have any questions please contact Jordan Bell at jordan@appleridge.org. Thank you!

Summer Camp Health Form

Child's First Name*
Child's Last Name*
First and last name of the person completing this form.*
Email Address of the person completing this form.*
Phone Number of the person completing this form.*
Doctor's Name*
Doctor's Office Address*
Doctor's Office Phone Number*
Please check any condition the camper has had.
- Diabetes
- Asthma
- Epilepsy
- Bee Sting Allergy
- Food Allergy
- Bleeding Disorder
- Sickle Cell Anemia
- Heart Condition
- Medicine Allergy
- ADD/ADHD
- Autism
- Oppositional Defiant Disorder
- Other Behavioral Disorder
- Other Notable Medical Disorder
Please explain any items checked in the previous question.
Does your child take any medications*
- Yes
- No
If yes, list the medication and how often your child takes it.
Does your child need to take medication during the camp day?*
- Yes
- No
If you answered yes to the previous question, what is it and please provide instructions for giving the medication.
Emergency Contact Name*
Emergency Contact HOME or CELL Phone Number*
Emergency Contact's WORK Phone Number*
By selecting this box you agree that all the information in this form is correct and give Apple Ridge Farm the permission to contact the doctor or send the child to the hospital or release this information with the physician listed above.*
- Yes
Type your name below as your signature for this form*
By clicking the button below you are agreeing that your child will attend camp from June 15 - July 23, 2026.*
- My child will attend camp
- My child WILL NOT attend camp

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PO Box 13463
Roanoke, VA 24034

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