Camp Medication Authorization Form
Complete this form within 24 hours prior to your camper's arrival. All medications must be listed on this form and be turned in at check in. They must be in original containers. Parent/guardian authorization is required via this form in order for us to administer any medication..
Camper Full Name
*
First Name
Last Name
Church/City
*
Cabin # (to be filled in at camp)
Parent Day Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Evening Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medications (Name, Dosage, Hour to Be Given)
*
Comments/Instructions
I also give camp staff approval to provide Over The Counter medication such as Ibruprophen, Pepto and others if necessary for my student and I understand that this will be recorded and that I will be informed of anything provided for my student at the close of camp via text or email within 48 hours of the event's closure.
YES, I give permission for OTC medication to be given
NO, I do not give permission for OTC medication to be given
Parent/Guardian Signature
*
Date (completed within 24 hours prior to camp arrival)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Medication Form
Submit Medication Form
Should be Empty: