Camper Health Form

Special Camp's Health Form

Your camp nurse will have this form with her at all times. Most medications will be distributed during meals. Only special meds will be given at other times. Please list medications, dosages and time of day on this sheet. Please call the camp office if any medications change prior to camp.

Camper's Name*
First Last
Camper's Weight*
Camper's Parent or Guardian's Name*
First Last
Parent or Guardians's Phone*
Medications allowed
- Tylenol
- Advil / Ibuprofin
- Tylenol PM
- Pepto Bismol
- Maalox
- Immodium
- hydrocortisone
- Tums
- Melatonin
Please check any medications the camper may take while at camp
Allergies*
Please list all know allergies including foods, drugs, plants, animals, or any other. If your camper has no known allergies, please list NO KNOWN ALLERGIES.
Medication Instructions
Please provide any specific medicinal dispensary instructions including: give with food, give with water, etc...
Breakfast Medications (8-9 a.m.)
Please indicate Medications and Dosage
Lunch Medications (12-1 p.m.)
Please indicate Medications and Dosage
Dinner Medications (5-6 p.m.)
Please indicate Medications and Dosage
Bedtime Medications (8:30-9:30 p.m.)
Please indicate Medications and Dosage