Sponsored by Harvest Fields Community Church
2626 E. Tremont Avenue, Bronx, NY 10461
August 10-14, 2020
Instructions: This form must be completely filled out. The information is vital to the health and well being of the child.
Explain any unusual family circumstances that make camp especially important for the child: (for example: recent crisis, being moved in foster placement, severe economic needs, etc.)
Indicate all known allergies, illness, disabilities, physical limitations or medical complications:
If "Yes" please fill in the following:
I understand that it is my responsibility as caregiver to make sure that all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp. I hereby authorize RFKC’s nurse to administer the above medication as listed from August 10 through August 14, 2020.
PLEASE NO CELLPHONES, CAMERAS OR MONEY. THESE ITEMS ARE NOT NEEDED AT CAMP.