Medical Information and Special Needs
Medical problems of which the camp staff should be aware:
Allergies (describe symptoms and treatment)
The child carries an epipen:
The child's Measles immunization is up to date:
The child's Mumps immunization is up to date:
The child's Rubella immunization is up to date:
Chicken Pox information:
Child has had chicken pox
Child has not had chicken pox
Child has been vaccinated against chicken pox
your child on any regular medication? If so, what is it and how is it
administered? If we need to oversee your child taking it, please
provide the details.
you child been diagnosed with any sort of behavioral or physical
disability? If so, please describe it and suggest strategies you've
Does your child require a special aide or some sort of special consideration at school? Please explain.
there something in your child's life that might impact his or her
experience at camp (an unusual family situation, difficulty in reading
or writing, a physical problem or recent illness, a fear of the dark,
etc.)? Please describe.
Camper's swimming ability: