Girl Scout Summer Camp Health History Form
Must have a physical within 24 months of your arrival at camp
To be completed by ALL Girls & Adults attending our Girl Scout Summer Camp Programs.
Campers without proper medical forms will NOT be allowed to remain on camp property per the New York State Department of Health's mandate.
To be completed by ALL Girls attending our Girl Scout Summer Camp Programs.
Emergency Medical Authorization:
In the event of a non-life- threatening emergency, if reasonable attempts to contact me or the emergency contacts at the above listed phone numbers have been unsuccessful, I hereby give GSNENY staff my consent to transport my child to an accessible hospital facility, and for administration of emergency medical treatment by any licensed physician, midlevel provider under physician direction, or dentist to order x-rays, routine tests, secure proper treatment for, order injection, anesthesia, or surgery for my child. I understand I am responsible for the cost of medical care. To my knowledge, the health form is correct, and my child has permission to engage in all camp activities except as noted by me and or her physician. I give permission to photocopy this form for out of camp trips and I understand the information on this form will be shared on a need to know basis with camp staff.
To be completed by ALL Girls attending our Girl Scout Summer Camp Programs Who will need to take medication either over the counter or prescription and needs a Physician's Authorization
STANDARD OVER THE COUNTER/PRN MEDICATION
The following medications are available in the infirmary and will be administered at the discretion of our health supervisor, if approval is indicated by the child’s health care provider. If you daughter has specific OTC medication she prefers, please bring that with you in the ORGINGIAL box/packaging AND it must be listed and signed by a doctor to be administered. Not on the list, ask your doctor to add it.
PRESCRIPTION MEDICATIONS: Please complete the patient’s current regimen for both scheduled and PRN medications – Upload additional information if necessary.
MEDICATIONS MUST BE SENT TO CAMP IN THEIR ORIGINAL PHARMACY CONTAINERS & MATCH CAMPERS NAME
I have examined the individual described and reviewed her health history. This individual is in satisfactory health, free from communicable diseases, and able to participate in camp activities.