The information on this form is not part of the camper or staff acceptance process, but is gathered to assist us in identifying appropriate care. Any changes to this form should be provided to camp health personnel upon participant's arrival in camp.
Please list ALL medications (including over-the-counter or nonprescription drugs) taken routinely. Bring medications in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.
Emergency authorization: I hereby give permission to the medical personnel selected by the camp director to order x-rays, routine tests and treatment for me. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for me as named above. I also understand that I will be held financially responsible for all medical expenses incurred. This form may be photocopied for use out of camp.
This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted.