Required fields are marked with asterisks (*)

Camp Allergy and Medication Form

If your camper has any allergies or requires any medication while at camp, please fill out the attached form prior to the start of the camp week.

Participant's name

Emergency contact information

Parent/guardian name

Daytime phone number

Cell number

Medical information

Which camp(s) is your child registered for (check all that apply)

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

Which camp are they registered in (check all that apply)

Wee Paddlers

Wilderness Adventures

Jr Explorers

Forest Rangers

Arts/Creative Kids

Sports Camp/Little Athletes

CIT

My child

has an allergy

requires medication

Parent/guardian authorization

I request that the above medication(s) be given during camp hours as ordered by my child’s physician/licensed prescriber. I release Town of Huntsville camp personnel from liability in the event of adverse reactions resulting from taking the medication(s). I will notify the camp of any change in the medication(s) (example: dosage change, medication is discontinued, etc.). I request that any remaining medication be sent home with the student on, or prior to the last day of camp. I will notify camp personnel if the medication should not be sent home with the participant. I understand medication is to be supplied in the original/prescription bottle.

Signature

Clear