Dhmh 4768-2026

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Click ‘Get Form’ to open the dhmh 4768 in the editor.
Begin by entering the child's name at the top of the form. This is essential for identifying the health history specific to your child.
Fill in the first emergency contact details, including the name and phone number of a parent or legal guardian. This ensures that you can be reached in case of an emergency.
Provide a second emergency contact who is not listed as the first contact, along with their phone number.
Next, enter your child's physician's name and phone number. This information is crucial for any medical needs during camp.
In the health information section, indicate if there are any health problems by selecting 'YES' or 'NO'. If 'YES', provide an explanation.
Similarly, address any medications, dietary restrictions, allergies, or special needs by selecting 'YES' or 'NO' and explaining if necessary.
For immunization information, specify the state or territory where your child resides and indicate if they are exempt from any immunizations.
If applicable, for campers residing outside the U.S., fill in the country of residence and attach form DHMH-896 as required.
Finally, ensure that a parent or legal guardian signs and dates the form before submission.

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