Camper Medical Log And Release Form printable pdf download

Camper Name: _______________________________________

Absolutely Incredible Kid Weekend

Camper Medical Log and Release

On the table below please list your child’s medication by name (using the name on the prescription bottle), and the required dosage.

Note that Camp Fire Camp Toccoa personnel can only administer the dosage as prescribed on the bottle.

In the “time given”

column circle the time your child should receive their medication as prescribed on the bottle. Please select “D” for dinner, “B” for

bedtime, or “BR” for breakfast.

Prescription medication must be received in its original container. Only the exact dosage required for your campers stay will be

accepted.

Upon check in the parent/guardian must turn in this completed form along with the prescribed medication to the Camp Fire Camp

Toccoa staff. Medicine should not be stored in the camper’s luggage.

Our house of health is stocked with over the counter medicine (aspirin, Benadryl, Tums, etc.). Due to our existing supply we will not

accept any of these medications from home. All inhalers, epi pens, etc. must be labeled with the camper first and last name.

Medication Name/Dosage:

Time Given:

Medication Name/Dosage:

Time Given:

Medication Name/Dosage:

Time Given:

Medication Name/Dosage:

Time Given:

Medication Name/Dosage:

Time Given:

Additional

instructions:___________________________________________________________________________________________

_____________________________________________________________________________________________________

Parent/Guardian Signature: _________________________________

Date___________________________

Camper Medical Log And Release Form