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
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
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.
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:
Information for camp nurse or doctor (i.e. procedures needing performed, etc):
Is the camper currently under his/her physician’s care? Yes No
All of my camper’s school immunizations are up to date? Yes ___ No___
Les syndromes démentiels I / Introduction. Le syndrome démentiel (SD) est un état d’affaiblissement intellectuel acquis, progressif, réversible ou non, entraînant un retentissement sur les relations sociales du patient et sur son autonomie Cette définition permet de le distinguer des débilités mentales et du syndrome confusionnel Il existe des critères diagnostiques de démence. Le
AMENDING APPROVAL PROVINCE OF ALBERTA ENVIRONMENTAL PROTECTION AND ENHANCEMENT ACT S.A. 1992, c.E-13.3, as amended. Pursuant to Division 2, of Part 2, of the Environmental Protection and Enhancement Act,S.A. 1992, c.E-13.3, as amended, approval is granted to the approval holder subject tothe attached terms and conditions for the following activity:the operation of the Fort McMurra