Daily/Regular Medication Consent Form
By filling out this form, you are agreeing for your child's medications to be packaged and managed by Mednow (www.mednow.ca), as is Camp Northland policy this summer.

DEADLINE: TUESDAY, JUNE 7, 2022
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Email *
Parent First and Last Name: *
Parent phone number: *
Parent Email (if different than the one above): *
Camper First and Last Name: *
Camper's Birthday: *
MM
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DD
/
YYYY
Campers Health Card Number (Please include version code)
Current Pharmacy Name: *
Current Pharmacy Phone number: *
Current Pharmacy address (if you have it):
How long will the camper be staying at camp? Please provide the start and end date of their stay.
*
Does the camper have allergies to any medications? *
If you answered yes, please list which medications the camper is allergic to. *
If you answered 'No' to previous question, please skip.
Please list ALL medications that are required by the camper including:  tablets, capsules, inhalers, creams, injectables, etc. Please also include any medications that are required on a when needed basis.  *
Any other relevant health information/supplies needed:
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