VACCINATIONS & MEDICATIONS

Name of person filling out this form:

First NameLast Name

Mobile/Daytime Number:

Area CodePhone Number

Email:

example@example.com

Is the person filling out this form the LEGAL GUARDIAN of all the young people to be registered?

STOP! This form can only be filled out by a LEGAL GUARDIAN. Futhermore, no young people can be listed on this registration form unless they are under the legal guardianship of the person filling it out.

TO COMPLETE THIS FORM, YOU NEED THE FOLLOWING THINGS:

How many young people will you be listing on this form (include Regular Campers, CIT's, Volunteer Counselors, and Staff):

Name:

First NameLast Name

Was this young person a student of South Lancaster Academy during this last academic school year?

Does SLA have up-to-date immunization records for this young person?

PLEASE NOTE: Because SLA has your child's immunization records on file, you do not need to submit them again to Camp Sonrise.

Please upload a scan or picture of their most current immunization records (PDF or JPEG).

Browse Files

You can upload multiple files

Will this young person need to bring any medications, prescribed or otherwise, to camp?

How many medications will he/she need to bring?

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Name:

First NameLast Name

Was this young person a student of South Lancaster Academy during this last academic school year?

Does SLA have up-to-date immunization records for this young person?

PLEASE NOTE: Because SLA has your child's immunization records on file, you do not need to submit them again to Camp Sonrise.

Please upload a scan or picture of their most current immunization records (PDF or JPEG).

Browse Files

You can upload multiple files

Will this young person need to bring any medications, prescribed or otherwise, to camp?

How many medications will he/she need to bring?

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Name:

First NameLast Name

Was this young person a student of South Lancaster Academy during this last academic school year?

Does SLA have up-to-date immunization records for this young person?

PLEASE NOTE: Because SLA has your child's immunization records on file, you do not need to submit them again to Camp Sonrise.

Please upload a scan or picture of their most current immunization records (PDF or JPEG).

Browse Files

You can upload multiple files

Will this young person need to bring any medications, prescribed or otherwise, to camp?

How many medications will he/she need to bring?

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Name of Medication:

This medication is:

Name of licensed prescriber:

Phone Number of licensed prescriber:

Area CodePhone Number

Reason for Medication:

Dose:

Time/Frequency:

Route:

Additional Instructions/Comments:

Known side effects (for this child):

Check if you agree:

I understand that medication prescribed for campers shall be kept in original containers bearing the pharmacy label, which shows the date of filling, the pharmacy name and address, the filling pharmacist's initials, the serial number of the prescription, the name of the patient, the name of the prescribing practitioner, the name of the prescribed medication, directions for use and cautionary statements, if any, contained in such prescription or required by law, and if tablets or capsules, the number in the container.

Check if you agree:

SIGNATURE: Place cursor in the box below, and hold down the button on your mouse to sign. If you're on a mobile phone, use your finger (you may need to turn the phone screen sideways.

Vaccinations & Medications

YOUTH #1

Medication #1

Medication #2

YOUTH #2

Medication #1

Medication #2

YOUTH #3

Medication #1

Medication #2

MEDICATION AUTHORIZATION