Outdoor Lab Medical Form - Three Creeks K8

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All 6th grade students and high school leaders must have a medical form submitted by a parent/guardian in order to attend Outdoor Lab.

Email *

STUDENT'S LEGAL first name *

STUDENT'S LEGAL last name *

STUDENT'S birth date *

YYYY

Parent/Guardian first and last name & Phone # *

Part 1: The following over-the-counter medications are available at both Mt Evans and Windy Peak and may be administered by the Outdoor Lab clinic staff when indicated. Check each medication that you give permission for the Outdoor Lab staff to administer.

Aloe Vera Gel

Acetaminophen (Tylenol)

Antacid (TUMS)

Benadryl (liquid, chewable, tablet)

Cough Drops

Eye Wash Solution

Okay to give

Part 2: The following over-the-counter medications are available at both Mt Evans and Windy Peak and may be administered by the Outdoor Lab clinic staff when indicated. Check each medication that you give permission for the Outdoor Lab staff to administer.

Gatorade

Hydrocortisone 1% Topical Cream

Ibuprofen (Advil/Motrin)

Insect Sting Relief Pad

Throat Lozenges (Chloraseptic/Cepacol)

Triple Antibotic Ointment (Nesoporin/Bacitracin)

Okay to give

What medications, supplements, medical devices, or emergency medications (i.e. inhalers, EpiPens, etc.) are you sending to Outdoor Lab? LIST ALL. *

If you are sending medications to Outdoor Lab please follow the link below for the required Medication Form. This form will need to accompany the medication(s) you have prepared/packaged for the trip and requires both parent and physician signatures. Without the completed, signed medication form medications will not be sent to Outdoor Lab. This may also result in the student being unable to attend. Provide completed form and medication(s) to the Health Room at your home school.

https://docs.google.com/document/d/1aJfULhIpKzB4nrO23wzzM_brsRIn_ExXPgnrbrmGqLQ/edit?usp=sharing

Or contact your school health room for a copy of the form

I certify that I have followed the above link and will send the printed/signed form with any medications that I am sending to Outdoor Lab. *

Yes.

Not Applicable.

Does your student have any health conditions/concerns or a recent injury/hospitalization? If yes, please LIST ALL below. *

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