Medical Release Form

Date:

In order to help serve your child best we are asking that this form be filled out to ensure your child's medication is properly administered. This form must be received by the first day of Camp.

Medication will be kept at the registration desk at all times. We ask that your child does not bring medication to camp without our knowledge. This includes over the counter medications as well. Medication must be brought in its orignal packaging with the chlid's name on it.

Medications that must be carried with the child (epi pens and puffers) need to be labelled and remain with the child. If the child is not old enough to carry his/her own medicaiton, please indicate this on the form.

Is your Child bringing any medication with him/her?

Yes No

if yes, please list:

Is your child responsible and capable to carry his/her own puffer/epi pen? Yes No

Remember all other medicaiton will be held at our registration desk.

Explain how the medication is to be administered in detail. Please note medication must be in original packaging and labelled

Child's Name:

Parent's Name:

You are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

Parent's Signature:

Date:

Don't forget to go back and complete the rest of the registration form.

Description

Please fill out this form and click submit.

Medical Release Form

Description

Please Fix the Following