Medications & vitamins to be taken at camp:

Medications & Vitamins to be taken at camp:
Medication Name Dose
What happens if
dose is missed?
Big Lake Health Information Form - 2014
Please bring this form with you – this form MUST accompany your child to camp, either by bus or private transportation. The form is to be completed no more than 7 days prior to the Over-the-counter medications wil be available while your child is at camp if needed. The
camp medication supply includes, but is not limited to the list below. These medications may be administered under the direction of the camp nurse/doctor. Dosages wil be as listed on labels. Generic equivalents may be used if available. Please check YES if you approve or NO if you do not approve of the medication being used (for each medication): Emergency Contact: If I’m not available in an emergency, please contact in the
following order:
 Tums (upset stomach/nausea/indigestion)   Throat Lozenges (sore throats) ( 1 ) Hydrocortisone, antibiotic ointment, etc) *It is our desire to provide the best health care for your camper while he/she is with us.
This form is to be completed and signed by the parent or guardian whose name appears
on the front page.
No camper can be accepted without this form.
If coming to camp by bus, this must be presented in order to board the bus.
If arriving at Big Lake by any other means, this form must be presented at the
time of registration.
This health history is correct and the person herein described has permission to engage in all prescribed activities, except as noted by me and/or the physician. In the event I cannot be reached in an emergency, I hereby give my permission to the physician in charge to hospitalize, secure proper anesthesia, or to order injection or surgery for my son/daughter. I also give permission to the nurse/doctor to give over-the-counter medications as listed above including Camper Health Insurance Information*
but not limited to pain medication, cold and flu medication unless otherwise noted. I understand that every effort wil be made to contact me if my child is ill or injured. A photo copy of this authorization shall be as valid as the original. Employer_______________________________ City/State:
Policy Holder:________________________________Birthdate: Parent’s Signature
Policy/Member Number________________________Group Number: *Big Lake Youth Camp carries an accident insurance policy on each camper. In case of an emergency, hospitals require this information as wel . Camper Medical Information
Camper Interaction Information
Please help us make your child’s Big Lake experience even safer by completing ALL of Please help us make your child’s Big Lake experience even more valuable with your suggestions and comments for our staff. Please check (√) all conditions that the camper currently has or has had in the past: Information for the counselor concerning activities, restrictions or behavior needs: _

Activity Restrictions
Information for camp nurse or doctor (i.e. procedures needing performed, etc):
Is the camper currently under his/her physician’s care? Yes No Reaction
Hospitalization/Surgery/Broken Bones
Immunization Status:
All of my camper’s school immunizations are up to date? Yes ___ No___


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