Permission & Acknowledgement Form

Permission & Acknowledgement Form
Parent or Guardian Name*

First NameLast Name
Child(ren)'s First and Last Names*
Do the above children reside in the USA?*

YesNo
Health Info
Do any of the above children have immunization exemptions for health reasons? If yes, list the children and exemptions.*
Do any of the above children have a health condition that may warrant administering medication (other than allergy or anaphylaxis medication)?*

YesNo
If yes, complete the following Medication Administration Authorization Form. Please note, there are portions which are required to be completed by your physician.
Do any of the above children have allergies or asthma that require a medical intervention such as albuterol, epipen?*

YesNo
If yes, please complete the following Asthma Action Plan and/or Allergy/Anaphylaxis Action Plan as necessary. Please note there are portions on this form which will need to be completed by your health practitioner.
If you answered yes to either of the above questions, then please be sure to contact Camp Lemaalah ASAP to set up a time to provide them with the medication. Important: All medication must be brought to Camp by the parent/ guardian in the original container with the pharmaceutical prescription attached.

If you are providing the camp with any medication; please sign the following Medicine Disposition Form.
Sunscreen/Bug Spray

We encourage you to apply sunscreen on your children prior to their arrival in camp. However, we understand it may not always be feasible and they may need another application.
The camp has my permission to administer sunscreen (name of brand) blanks*or bug spray as they deem appropriate.
Acknowledgement of Receipt of Camp Policies and Activities

I have read the parent handbook and understand the policies and activities of Camp Lemaalah and have been informed. I allow the above children to participate in camp activities on and off campgrounds, including swimming and all trips.
Signature*

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Camp Lemaalah is hoping to offer they will be offering FREE hot lunches once again. If so, do you want all your children to receive the hot lunches?*

YesNo
If no, please list the names of the children you do not want to receive hot lunches.
Should be Empty:

Permission & Acknowledgement Form

Health Info

Sunscreen/Bug Spray

Acknowledgement of Receipt of Camp Policies and Activities