Medical forms for 2010
Please note: Camp S'dei Chemed provides for an additional medical insurance to cover all our campers in case of emergency. There is no charge.
The forms are from our insurance company so please don't be upset at us if you find it a bit confusing. The purpose of the forms are to notify the insurance of preexisting medical issues that will not be covered. The medical forms do not need to be filled out by a doctor.
Click here to read the medical policy
Instructions on filling out medical form. Please read carefully.
Option One - easy and quick!
Use this link below to fill out the pdf online without having to print out and fax. Make sure to read below where it says how to fill out the form.
How to fill out the forms
1. Page 1 - Complete the health questionnaire with yes and no for each line.
2. Page 2 - Where it says
details
of positive findings enter information for any box that you checked yes for on
page 1.
Where is says
Declaration of insurance candidate fill out appropriate
information.
Under passport number enter date of birth.
For signature use the write tool (available at top of page) to sign.
Ignore the rest of
the page.
3. Click the link that says Save and Return
Option two - print and fax
1. Page 1 - Complete the health questionnaire with yes and no for each line.
2. Page 2 - Where it says
details
of positive findings enter information for any box that you checked yes for on
page 1.
Where is says
Declaration of insurance candidate fill out appropriate
information.
Under passport number enter date of birth.
Ignore the rest of the page.
4. Fax all pages to us at 347- 823-1183.
* Please be aware that camp purchases this as an additional insurance, however anything not covered by this policy is your responsibility.
Feel free to call us with any questions. 718-338-2785
