Kids Camp Medical Information Form

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Kids Camp Medical Information Form

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* Indicates required question

Camper's Name *

Your answer

Parent/Guardian Name *

Your answer

Medication *

Your answer

Prescription # *

Your answer

Time of day medication is to be given *

Your answer

Method of giving dosage *

Your answer

Amount of each dosage *

Your answer

Reason for medication

Your answer

Physician *

Your answer

I herby authorize the Kids Camp Administrative Staff to administer the prescribed medication tomy child as provided. I understand that a medication log record will be kept on file. Parent's Signature:

Your answer

Parent's contact number *

Your answer

Parent's alternate contact number

Your answer

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