2020 Emergency Contact and T-Shirt Order

2020 Emergency Contact
and T-Shirt Order
(please complete one form per child)
* Indicates Response Required
Please Note
Prior to beginning this medical form, you may wish to gather the required information for each child.
Information Required
*Physician Signed Medical Form See note below.
Emergency Contact Information
Medical Conditions, Medications and/or Allergies
Child's Physician and Phone Number
Health Insurance Company and Policy Number
Please Note
*The Physician Medical Form is required for all Little Gulls, Big Skippers and Tween participants who have allergies and/or medical conditions - due to COVID-19 and many medical facilities being closed, if an updated waiver is unable to be obtained, the CT Department of Early Childhood has allowed a 2019 form to be used. If you are able to schedule an appointment with your child's pediatrician, the attached form must be printed and brought to a doctor to be signed. Later in this form, you will be prompted to upload the signed form.
If your junior is not enrolled in Little Gulls, Big Skippers or Tween OR does not have allergies and/or medical conditions please disregard the physician signed waiver and simply complete the Emergency Contact Information.