The following non-prescription medications may be stocked in the camp Health Center and are used on an as needed basis to manage illness and injury. Please select those that the camper should NOT be given.
Has/does the camper:
Has the camper:
What have we forgotten to ask? Please provide in the space below any additional information about the camper's health and wellbeing that you think important or that may affect the camper's ability to fully participate in the camp program.
This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.