Medical Release Form and Release of Liability

All participants in Los Altos Recreation Department camps must have a medical release form on file.

Please fill out the form below and your information will be submitted electronically to the Recreation Department. Alternately, you may download a PDF of the form and email it to recreation@losaltosca.gov, drop it off at the Hillview Community Center during regular business hours, or bring it with you on the first day of camp.

Should you have any questions or need assistance, please contact the Recreation Department.

Child Information
Parent #1
Additional Parent/Guardian (Optional)
Emergency Contact #1
Emergency Contact #2
Medical Information
If none, enter "N/A"
If none, enter "N/A." Please be sure to enter medication name, amount to be taken, and frequency of dosage.
By typing my name above, I acknowledge that I have read the foregoing, and am fully aware of the legal consequences of signing this document.