The following informaiton must be filled out by the parent/guardian or adult camper or staff member over the age of 18. The intent of this information is to provide the camp health care personnnel the background to provide appropriate care. Keep a copy of the completed form for your records. Any changes to this form should be provided to camp health personnel upon participant's arrival at camp. Provide complete information so that the camp can be aware of your needs.
Please fill out either the left hand questions (if US Citizen) or right hand questions (if not a US Citizen).
Provide Department form DHMH-896 from the
Maryland Department of Health and Mental Hygene.
(record of vaccination or immunity)
Upload or Mail form to the Camp Director.
MARYLAND STATE LAW REQUIRES WRITTEN PHYSICIAN PERMISSION FOR ALL MEDICATION TAKEN AT CAMP, PRESCRIPTION AND OVER THE COUNTER. PLEASE PRINT THE MEDICATION AUTHORIZATION FORM FROM THE ROUNDUP WEB SITE AND SIGN IT. OBTAIN YOUR PHYSICIAN'S SIGNATURE, AND RETURN IT VIA EMAIL OR MAIL TO THE CAMP DIRECTOR. YOU MUST FILL OUT ONE FORM FOR EACH MEDICATION, PRESCRIPTION AND OVER THE COUNTER.
If for religious reasons, you cannot sign this, contact the camp director for a legal waiver which must be signed for attendance. Call Amy Schisler at 410-725-1693 or email email@example.com
All Non-Girl Scouts, including adults, MUST be registered as a Scout in order to be covered by our insurance. If you are not already a registered Girl Scout, please follow the link to PERSONIFY on the forms page or in your confirmation email. A copy of your registration receipt must be sent to firstname.lastname@example.org