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Diabetic Information Form - School Year

Diabetic Information Form - School Year

Please provide additional information regarding student's medical condition. Based on responses SEACAMP San Diego may ask for additional information and/or a Physician's Release for Activities.

If last event is within 1 year, students will be required to have a physician’s signature on the following physician’s release form in order to participate in Field Activities.
As the parent or guardian of above student
As the parent or guardian of above student
My child is currently using some technology to assist with management of diabetes.
My child manages diabetes through use of
As the parent/guardian of above student
As the parent/guardian of above student

Student Manages Diabetes Through Food Choices

Please note our meals are provided by an outside caterer. Student is responsible for making good/appropriate food choices. Caterer is not able to provide carbohydrate counts for meals.

As the parent/guardian of above student
My child will need low carbohydrate meals (carb amounts unspecified) during camp session(s)

Parent/Guardian Signature

Electronic Signature Consent
07/12/2024