EMS Symposium 2019 Youth and Teen Camp Student Information Form

Thank you for registering your child for the 2019 Virginia EMS Symposium Youth and Teen Camps.  Please complete the form below as soon as possible, but no later than October 25, 2019.  Please contact Adam Harrell via email (adam.harrell@vdh.virginia.gov) or phone (804-888-9101).

Symposium Youth and Teen Camp Student Information Form

  • Date Format: MM slash DD slash YYYY
  • Youth Camp - ages 8 to 12 | Teen Camp - ages 13 - 17
  • If no medications are taken, please type "No medications taken"
  • If no allergies to food or medication, please type "No known allergies"
  • Any information you feel the camp instructors should know (i.e. does your child have a nickname they prefer).
  • Please enter the insurance information (Insurance company name, policy number, group number) or provide a copy of the card
  • Drop files here or
  • Emergency Contact Information

  • Shirt and Lunch Order

  • Included with the Youth/Teen Camp Registration is a lunch cruise for the children on the Spirit of Norfolk. Their lunch will be buffet style, but please let us know if there are any special requests. We will do what we can to accommodate, but cannot guarantee all requests will be honored. All allergies will be accommodated.
  • We have limited availability for parent chaperone(s) on the lunch cruise. There is no cost for this opportunity. Interested chaperones will be contacted prior to the symposium to confirm your attendance as a chaperone.
  • We will be ordering 2 shirts per child, so please make sure the size you request is correct