Stratham Recreation Department
Trip Information &
Medical Emergency Information
So we can better assist you in the event of an emergency,
Please fill out the below information to the best of your ability.
You may mail this information to: Stratham Recreation Department
c/o Tara Barker
Name: ________________________________ Phone: _______________________
Name of Emergency Contact: ___________________ Relationship: ________________
(not traveling with you)
Emergency Phone Contact: (h)_____________ (w) _____________ (c) _____________
2nd Emergency Contact: _________________________Relationship: ________________
Emergency Phone Contact: (h)_____________ (w) _____________ (c) _____________
Primary Care Physician: ____________________ Phone: _______________________
Insurance Company: _______________________ Policy #: ______________________
Medication we should know about? __________________________________________
Allergies? _______________________________________________________________
Medical Conditions we should know about?____________________________________
Any other information you would like to share?_________________________________
____You are staying in a double hotel room with _____________________________________
____ You are staying in a triple hotel room with ______________________________________
____ You are staying in a quadruple hotel room with __________________________________
Reminders: Our trip is 2 full days in duration, please pack accordingly. Please review the information sheet regarding typical temperature and weather for the area during our stay. Don’t forget to bring the following items on your trip…
Dramamine (or motion sickness medicine- just in case!) J, Camera and plenty of film (memory card, battery charger etc.), Reading material, Sunglasses and sunscreen, Jacket and/or rain gear
Red Sox