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CAMP MISAWANNEE MEDICAL WAIVER FORM

IMPORTANT: Health form must be submitted to our camp office upon registration.  Updates can be submitted later by email.  Please ensure it is filled out completely & accurately.  Campers cannot attend camp without a current health form on file prior to camp.

CAMPER INFORMATION

EMERGENCY CONTACTS

MEDICAL INFORMATION

ALLERGIES

Does your child have allergies?
If yes, what are they allergic to?

EPI-PEN

Does your child require an EpiPen?

***If your child is required to carry their EpiPen (.e. bee/wasp allergy), please provide two non-expired EpiPens; one for your child to carry with them and one to keep in the Health Centre.***

DIETARY RESTRICTIONS

Check all dietary restrictions
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ASTHMA/INHALER

Does your child have asthma? If yes, indicate severity:

If your child will be carrying their puffer with them, please bring an extra non-expired puffer to be left in the Health Centre.  If you child has used their puffer in the last year, they are required to have a puffer at camp.

MEDICATIONS AT CAMP:

Will your child be taking any medications while at camp (prescription or homeopathic)?

***ALL PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS MUST BE LEFT WITH THE HEALTH CARE STAFF WHILE AT CAMP***.  Prescription medication brought to camp must be in its original packaging and must be labeled with the doctor's name, child's name, dosage, schedule, route and date.  If any over-the-counter medications are sent to camp with your child, they must be in the original package and left with the Health Care Staff.***

MEDICATIONS AT HOME/TREATMENTS:

Does your child regularly take any medications that will NOT be taken at camp?  Will your child require any treatments while at camp?  

OVER-THE-COUNTER MEDICINE AT CAMP

May the following over-the-counter medications be given to your child while at camp, if deemed necessary by the nurse or first aid attendant?

Select those you will allow (if necessary):

HEALTH HISTORY

Has your child experienced or is currently experiencing any of the following conditions:

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ACTIVITY RESTRICTIONS/OPERATIONS/HOSPITALIZATION/SERIOUS INJURY:

IMPORTANT REMINDERS & WAIVER - please read carefully!

  • I understand that all information collected will be used to diagnose, treat or maintain my child's physical or mental health and to assist in preventing disease or injury or to promote health.  This information is considered to be confidential and will be shared amongst health care providers as needed.  ie: Camp Director, Camp Nurse, First Aid Attendant, Camp Counsellor.  Walk in Clinic or Emergency Health Care Providers.  This information will only be shared with the Camp Director and Camp staff on a need to know basis to ensure the physical and mental health of. my child.

  • To the best of my knowledge, my child is in good health.  I will notify the camp in writing prior to arrival if there is any change in my child's health, or she is exposed to any communicable disease within 3 weeks prior to arrival at camp.

  • I agree to reimburse the camp for any prescriptions or medical expenses incurred for this camper.

  • I will submit any changes to this health form in writing to the camp prior to arrival.

  • At each camp there will be medical staff as follows:​

    • Day Camps in July will have a Level 2 Certified First Aid Attendant on site for the duration of the camp.

    • Overnight Victoria Camp will have a First Responder on site for the duration of camp.

    • August Overnight Camp will have a Registered Nurse on site for the duration of camp.

Medical Release:  I, the parent or legal guardian of the camper mentioned above, hereby delegate the authority to the Leaders of camp to arrange whatever medical treatment they deem necessary during my daughter’s stay at camp. I hereby declare that the camp staff shall not be responsible for any injury or loss suffered by my daughter except insofar as any such loss is solely attributable to the negligence of the staff of camp acting within the course of their duties. I further consent to the transportation of my daughter from the camp to the nearest hospital or clinic.

Which camp will your daughter be attending?
Thank you for submitting your Medical Waiver form.
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