Health Form

Please fill out a form for each camper and yourself if you are volunteering.

All medications must be in a labeled container (example: Tylenol bottle) and prescription medications must have the pharmacy label attached.  All medicines will be held by the Camp Nurse except those used on an "as needed" basis (Epi-pen, inhaler, etc.).

I understand that the information on this form will be used to keep me safe in the event of an accident or sudden illness, and it will be used to seek medical treatment.  I hereby give my permission to the staff representative(s) at the Girl Scouts of Kentucky’s Wilderness Road Council and/or the troop/group leader(s) and/or chaperone(s) of me to seek emergency medical treatment due to an accident or illness while participating in Girl Scout activities.

I understand my emergency contact will be notified as soon as possible.  In the event they are unreachable, I authorize the hospital and/or physician(s) to administer treatment and the release of any records necessary for insurance purposes. I understand that I am responsible for any balance that is incurred from the hospital and/or physician.

I understand that the information on this form will be used to keep my child safe in the event of an accident or sudden illness, and it will be used to seek medical treatment.  I hereby give my permission to the staff representative(s) at the Girl Scouts of Kentucky’s Wilderness Road Council and/or the troop/group leader(s) and/or chaperone(s) of my child to seek emergency medical treatment due to an accident or illness while participating in Girl Scout activities.

I understand I will be notified as soon as possible.  In the event I am unreachable, I authorize the hospital and/or physician(s) to administer treatment to my child and the release of any records necessary for insurance purposes. I understand that I am responsible for any balance that is incurred from the hospital and/or physician.