Medical Camp_health_form_parent_authorization

Camp Parent Authorization Michael Muskepo UnitedHealthcare 911-87726-04

ID: ce1df3192d4010b5

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Details

Category
Vendor
CampMinder / UnitedHealthcare
Date
Apr 21, 2014
Processed
Sep 13, 2026 1:11 AM EDT
Original File
M. Muskepo - insurance card.pdf

Summary

Signed camp health form parent authorization for Michael Muskepo (birth date 04/22/2002, Session 1: 6/15-6/27) with attached UnitedHealthcare Choice Plus insurance card copies for member Johan Jongsma, signed 4/21/14.

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