Clone of Individual Medication Card 2025

King Solomon Christian Camp

Individual Medication Card 2026
We require separate information for each different medication your child/student will be bringing with them to camp. All medications, whether prescription or over-the-counter, need to be sent to camp in their ORIGINAL packaging.
Camper's Name:*
Camp Attending:*
In total, how many different medications will be sent with your camper? (including both prescriptions & over-the-counter medications)*
Medication 1
Medication 1 Name:*
Reason Medication 1 is prescribed/used:*
Dosage (Med 1):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
Does your child have any additional medications for which you need to provide information?*

Medication 2
Medication 2 Name:*
Reason Medication 2 is prescribed/used:*
Dosage (Med 2):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
2.) Does your child have any additional medications for which you need to provide information?*

Medication 3
Medication 3 Name:*
Reason Medication 3 is prescribed/used:*
Dosage (Med 3):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
3.) Does your child have any additional medications for which you need to provide information?*

Medication 4
Medication 4 Name:*
Reason Medication 4 is prescribed/used:*
Dosage (Med 4):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
4.) Does your child have any additional medications for which you need to provide information?*

Medication 5
Medication 5 Name:*
Reason Medication 5 is prescribed/used:*
Dosage (Med 5):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
5.) Does your child have any additional medications for which you need to provide information?*

Medication 6
Medication 6 Name:*
Reason Medication 6 is prescribed/used:*
Dosage (Med 6):*
Before or with BreakfastBefore or with LunchBefore or with SupperAt BedtimeAs NeededOther
If your child has more than 6 medications, please sign and submit this form with its current information, then go back to the form at https://form.jotform.com/kingsolomoncamp/IMC26 to complete the additional medication information. Thank you!

Medication 1