Medical Registration

  • Medical Registration

    To be completed by anyone coming on the Camp Bountiful property, at any time during camp.

  •  Participant Information

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  • Medical Insurance Information

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  • Medical Information to be Provided

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  • Medical History

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  • ****Medical Information/Emergency Contacts/Consent****

  • Medications: ALL MEDICATIONS MUST BE CHECKED IN TO THE HEALTH SUPERVISOR AS DIRECTED

    List Prescription medications that will be taken by camper while attending Camp.  If there are any changes to this list prior to the beginning of Camp, such changes MUST be communicated to the Health Care Supervisor before arrival at Camp. All medication must be in original container with original pharmacy medication sticker including camper’s name. 

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  • Over the counter Medications (OTC): May be maintained by the Health Care Supervisor for use as needed. 

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  • Special Instructions:

  • Consent to Treat: The following authorization shall remain effective for the duration of Young Women’s Camp.

    I, *, the undersigned, as parent/legal guardian, or myself state the above noted medical and health information is true and correct so far as I know and hereby authorize the Camp Health Supervisor, Camp Director, qualified members of the Young Women’s Camp Staff, or driver of a transporting vehicle to obtain first aid or other care as seems prudent to above named individual in the event of accident or illness.

    I understand I will be held responsible for any medications brought to camp by person herein described. I hereby give permission to administer prescribed medication as well as over the counter medication according to as is indicated above.  

    I further authorize said persons to initiate any or all provisions for medical and/or surgical care for above named individual, including anesthesia, which may be deemed necessary or advisable by any licensed First Responder, Emergency Room Personnel, or Physician.  

    I assume and shall be responsible for all medical costs and expenses in connection with the care and control of above named individual, except in so far as there is applicable insurance covering the same. 

    In the event of an incident requiring medical attention I expect that every effort will be made to notify myself or the below named emergency contacts.

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  • Emergency Contacts:

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