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Maine Outdoor Kids Health & Support Information Form

This information helps our staff create a safe, inclusive, and supportive experience for your child during outdoor programming. Please share anything you feel is important for us to know.

Date of Birth
Month
Day
Year
Does your child have any allergies or asthma that could affect participation?
No
Yes — please describe
Please share any health conditions, injuries, or medical considerations that may affect your child’s participation, comfort, or safety in outdoor activities:
None to note
Yes - please describe below
Does your child benefit from extra support related to learning, attention, sensory needs, behavior, or emotional regulation in group or outdoor settings?
No
Yes

If you answered yes to any of these questions, we will follow up with you to gather additional information.

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