Page

Similar documents
Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History

South Shore Stars 2015 Summer Camp and Fall Enrollment

2018 Medical Waiver and Release

Camp St. Charles ANNUAL HEALTH FORM CHECKLIST

Date Camper Name: LAST, FIRST (Please print) Medical Form

Camper Health History form must be on file prior to arrival at NEMC

Registration Information and Fees

MARYLAND 4-H CAMPS HEALTH FORM

2015 Camper Health Form

2019 Registration Form

Dates will attend camp: from to Month/Day/Year Month/Day/Year. Male Female Birth Date Age on arrival at camp Month/Day/Year

CAMPER HEALTH HISTORY FORM 1

CAMPER HEALTH HISTORY FORM 1

CAMPER HEALTH HISTORY FORM1

MARYLAND 4-H CAMPS HEALTH FORM

Summer 2017 Health Form Break Down

Health History & Emergency Form

Camp Zanika Required Camper Forms

Camper Information. Street Address Apartment/Unit # City State ZIP Code. Parent/Guardian Information. Last First M.I. City State ZIP Code

Camper Application. Legal Guardian #1 Information. Legal Guardian #2 Information: Family Status: Mailing Address: Address: City: State: Zip:

Peterkin Camp and Conference Center

NetXtreme Intro Sheet

Forms A-C must be completed and sent to the Camp Floyd Rogers office and postmarked by June 1 st. Camp Floyd Rogers PO BOX Omaha, NE 68154

CAMP MCCUMBER. Overnight Camp. Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme

YMCA Hayo-Went-Ha Camps Instructions for Medical Form

2013 BFA Jr. Balloonist Hot Air Balloon Camp Camp Registration Form Reno, Nevada

Camper s Name Last First Middle Date of Birth Age Today s Date. Mailing Address City State Zip County Sex Race

CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017

Camper Application. DATE: Monday-Friday, June 18 - July 27 (Excluding July 4) 9 am - 12 noon. FREE! [Member] $20 [Non-Member]

Lake Geneva Youth Camp Health Certificate

Indian Valley Boys & Girls Club 2018 Summer Day Camp Registration Form PLEASE CIRCLE SHIRT SIZE: CAMPERS NAME: HOME PHONE: ADDRESS:

Ben Lomond Quaker Center Summer Youth Camps Box 686, Ben Lomond, CA (831) ENROLLMENT FORMS

IMPORTANT NEMC CAMP FORMS

Overnight Camp 2018 Camper Information and Medical Form

2017 Medical Form Carolina Raptor Center Summer Camp

YMCA CAMP PINEWOOD 2014 Summer Camp Registration

Please mark which days your camper will be attending. ($15 a day or $70 for all week)

PARENT / GUARDIAN: PLEASE FILL OUT AND SIGN THIS PAGE.

KIDDO CAMP PACKING LIST

Dates: 6/25-6/29 Monday - Friday (day camp 8:30am - 4:30pm)

As the parent/guardian of I choose not to have a medical. Personnel FORM 2.

DHAC School Vacation Camp

American Indian/Alaskan Native Black or African American Hispanic/Latino Asian or Pacific Islander Caucasian/White Mix Other

2019 CAMP WARWICK R EGISTRATION FORM

Medical History Form

Rye Y Summer Camp 2018 Registration Checklist

Please circle shirt size and check Youth or Adult: Shirt Size S M L XL XXL 3XL other: 4-H Member is active in 4H Online:

Camp Celo. Medical Form Package Instructions:

CAMP SUNRISE LAKE 2019 REGISTRATION

Please return this form to your hosting branch.

Camper Authorization for Medical Treatment and Authorization to Pick-up Camper

Harvest Kidz Camp 2016

Marianne Askew and Sally Joyce

ESO Summer Camp 2018

PROGRAM INFORMATION: School s Out Activity Day 2012/2013 (ages: K-8 th ) January 21 February 18 March 25, 26, 27, 28 & 29 9:00am-6:00pm

Residential campers will report Sunday evening, and parents need to pickup Friday afternoon

Summer Art Camp 2015 Parent Orientation Guide

SUMMER AT THE YMCA 2019 Health History Form

Student Camper s Name Age: Student Camper s Name Age: Student Camper s Name Age: Junior Counselor s Name Age: Junior Counselor s Name Age:

2018 Camp Aristotle Forms and Information

2017 Houchens Day Camp

2018 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM

2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM

2018 Registration Packet

CAMP MSC SENSATIONAL SUMMER SCIENCE

Camp Hands Up 2018 Registration Form **Please Note: Prices are changed and see on the bottom**

Camper Forms Checklist-Camp Menzies

Overview. Camper Confirmation Packet Easter Seals Washington Camp Stand By Me

Dear Camper and Family:

Eastman Area 4-H Summer Camp

Cave Springs Camp Registration Form

2015 Catholic Scout Retreat The Diocese of Birmingham September 25-27, 2015 at Beautiful Camp Tekakwitha

Bayshore District Great Scouts! Outdoor Adventure Twilight Camp June 15 19, 2009 Youth Application

Area 14 Day Camp 2019 Celebrating You

Sunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12!

GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form

Girl Scouts of Area 10 Day Camp June 18-22, :30 a.m. 3:30 p.m. Camp Shantituck Shepherdsville, KY Registration Opens March 15

Washington County Recreation Department Robinwood Dr. Hagerstown, MD / CAMPER INFORMATION FORM

Day and Resident Camp

GIRLS LACROSSE Train Like a Tiger Clinic Camper Information Packet

CAMP JEANNE D ARC Medical Information Instructions for Parents/Guardians

GARAYWA CAMP & CONFERENCE CENTER 2018 Summer Missions Camp Registration Form

Minions: Take Me to Your Leader. Youth Camp: July Kids Camp: July T-Shirt is included in the Registration Fee! $255.

CAMP SUNRISE LAKE CIT Registration

All forms and the $25.00 registration fee must be completed and returned to us in order to start the enrollment process.

SOFTBALL Advanced Clinics Hitting, Pitching & Catching Camper Information Packet

Crex Meadows Youth Conservation Camp. Camper Application Form. First Last M.I. Date of Birth Age Gender

The Hammock House Summer Camp Programs nd Street West, Marathon, Florida

FORM /GUARDIAN PLEASE HEALTH PARTICIPANT PROGRAM PARTICIPANT HEALTH FORM, CONT. TO BE COMPLETED BY PHYSICIAN ARENT/G CAMPER

2017 Camp Requirements. Why does Mercy Street go to camp?

CALVERT COUNTY PARKS & RECREATION CALVERT COUNTY SHERIFFS OFFICE

Monday, Tuesday, and Wednesday: 9:00 AM until 4:00 PM

Instructions for Parents Registering Children for Camp Walter Johnson

2018 Day Camp Dates See you this summer!

CAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE

*MUST have independent bathroom skills.

CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015

2018 Application. Easy Online Enrollment: Application valid 1/16/18. New Jr. Camp Pricing!

2018 Summer Camp Packet

OVERNIGHT CAMP REGISTRATION PACKET

Transcription:

Page 1

Page 2

Page 3

Page 4 WE ARE ACA ACCREDITED! (AND PROUD!)

Page 5

Page 6 º º º º

Page 7

Page 8

Page 9

Page 10

Page 11

Page 12

Page 13

Page 14

Page 15

Page 16

Page 17

º Page 18

Page 19

Page 20

Page 21

Page 22

Page 23

KEEP UP WITH CAMP ALL SUMMER LONG! Stay in touch with your camper at Camp Wasiu II with Bunk Notes. Your message will be delivered to the camp within 24 hours. No need to wait for snail mail Bunk1 makes it easy to communicate with your child. Follow Bunk1 on Facebook and Twitter for the latest updates and deals! GET STARTED TODAY! Go to www.bunk1.com RETURNING PARENTS will login using their email address and password. NEW PARENTS will click Need an account or have an invitation code? and complete the basic form. The Invitation Code for Camp Wasiu II is: WASIUB1 You will be prompted to select a bundle for access to your Parent Portal. Bundles include credits for you to send Bunk Notes and enhance your notes with borders, photos, sports scores, and puzzles. SENDING BUNK NOTES Send Bunk Notes day or night! Your camp receives a pdf at 7am PST each day containing all Bunk Notes received in the last 24 hours. Camp prints each Bunk Note and delivers them to your camper with the regular mail. You can purchase more credits anytime in the Bunk Notes menu. On the go? Purchase Bunk Notes Express and receive a unique email address to send your Bunk Note directly from an email account. Your message is still delivered as a Bunk Note. Each time you send a message, 1 credit is deducted from your account. Your Bunk Note will not be sent via Bunk Notes Express unless you have credits in your account. FREQUENTLY ASKED QUESTIONS: Can other relatives use these services? Absolutely! In your Quick Links you ll select Invite Family Members, enter their details and they will be sent an email. PLEASE NOTE this will prompt them to set up their own account. It does not provide them access to your account OR your Bunk Note Credits. Questions or Problems? The Bunk1 team is available to support you 7 days a week during peak season. They guarantee a response within 24 hours and it's usually much quicker than that. Please call Bunk1 at 18884652267 or email support@bunk1.com.

Page 1 of 4 Camp Transportation Release Form This form must be completed for ALL campers under age 18, even if a parent/guardian is providing all transportation. Please print this form singlesided (not doublesided) and fill out all sections (including name, address, and parent/guardian info.), as this document will be separated from the rest of the packet. This form is to be filled out each summer for each camp program/event. Present this form at checkin. Participant Information Name Program name Street address City State Zip Parent/Guardian Emergency Contact Information First Custodial Parent/Guardian Telephone: Day Evening Cell Does this person have permission to pick up the camper? Yes No Second Custodial Parent/Guardian Telephone: Day Evening Cell Does this person have permission to pick up the camper? Yes No Please circle one response for each of the following statements. This MUST match your online registration. My camp is arriving at camp by: Car Bus from Reno Bus from Truckee My camper is leaving camp by: Car Bus to Reno Bus to Truckee Are there any custody situations of which we need to be aware? Yes No If yes, please explain. Please identify any additional persons who MAY pick up your camper. We cannot release campers to any individuals not noted on this form. This box must be completed for attendance. Name Relationship to camper Phone 1 Phone 2 Name Relationship to camper Phone 1 Phone 2 Name Relationship to camper Phone 1 Phone 2 I confirm that the individuals listed above have my permission to pick up my camper. I also understand that the adult picking up my camper will be required to show photo ID. Printed Name Date Signature This section is to be completed at pickup: I am an approved adult listed on this form. I am confirming that I am picking up the youth camper named on this form. Printed Name Date Signature

Page 2 of 4 Camp Health History Form for Children & Adults This form must be completed for ALL camp participants (youth AND adults). Please fill out the name and address section, as this document will be separated from the rest of the packet. The information on this form is gathered to provide camp health care personnel the background necessary to provide appropriate care. Please provide complete and correct information. Keep a copy of the completed form for your records. This form is to be filled out each summer for each camp program/event by parents/guardians of minors or by adults themselves. Please staple pages 2 4 together and present at checkin. Participant Information Name Birth date Age at camp Home address Street address City State Zip Parent/Guardian Emergency Contact Information First Custodial Parent/Guardian Telephone: Day Evening Cell Second Custodial Parent/Guardian Telephone: Day Evening Cell If not available, in an emergency, notify: Relationship to participant Telephone: Day Evening Cell Insurance Information Is the participant covered by insurance? Yes No If yes, copy of insurance card must be attached. If so, indicate carrier or plan name Group Insurance ID # Name of insured Relationship to participant Medical Providers Name of family physician Telephone Address Name of family dentist/orthodontist Telephone Address Is there anything we should know about the camper? Please describe any physical, mental, or psychological conditions requiring medication, treatment, or special restrictions or considerations while at camp. Dietary Restrictions Allergy Information Allergic to: Describe reaction and management of the reaction:

Page 3 of 4 Prescriptions and/or Daily Medications Medication Name: SUN MON TU WED TH FRI SAT Dose Time(s) to give Medication Name: SUN MON TU WED TH FRI SAT Dose Time(s) to give Medication Name: SUN MON TU WED TH FRI SAT Dose Time(s) to give My camper uses an EpiPen. Yes No If yes, should the EpiPen be kept on the camper, her counselor, or at the Health Hut? My camper uses an inhaler. Yes No If yes, should the inhaler be kept on the camper, her counselor, or at the Health Hut? Common overthecounter medications are stocked in the Health Hut and will be administered at the discretion of the camp health staff to your camper if permission is given below. Medication will be administered based printed label s symptoms and suggested dosage. Circle all that apply. Tylenol (Children s) Calamine and/or Caladryl Lotion Sudafed Tums Tylenol (Adult) Benadryl (Children s) Robitussin DM Neosporin Ibuprofen (Advil and/or Motrin) Benadryl (Adult) PeptoBismol Sun Screen Bug Spray/Insect Repellant Hydrocortisone Cream Overthecounter medication notes: This box must be completed for attendance. Parent/Guardian or Adult Authorization: This health history is correct and complete to the best of my knowledge. The person herein described has permission to engage in all camp activities except as noted. I understand and agree to abide by any restrictions placed on my participant in camp activities. I attest that all immunizations required for school are up to date and agree that the date of the last tetanus shot is provided. I hereby give permission to the camp to provide routine health care, administer prescribed medications, and seek emergency medical treatment including xrays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to the camp to arrange necessary transportation for me/my child. I have listed the medication dosage and administration instructions (if applicable). I authorize camp health staff to administer the above listed medications to my camper during her participation. I understand that GSSN is not liable for lost or damaged medical equipment. If I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. I understand every effort will be made to contact me or the emergency contact noted above before taking this action. This form may be photocopied for trips out of camp. Printed Name Date Signature

Page 4 of 4 THIS ENTIRE SECTION MUST BE COMPLETED BY LICENSED MEDICAL PERSONNEL FOR ALL CAMPERS (YOUTH AND ADULT) ATTENDING A CAMP WASIU II SESSION THAT IS FOUR (4) NIGHTS OR LONGER. A physical is required for ALL campers that are attending a Camp Wasiu II session that is four (4) nights or longer. The physical exam must be current within 12 months of the camper s first day at camp. Date of Examination Height Weight BP Please circle the appropriate number for each system examined during the physical. 1 = Within normal 2 = Abnormal finding 3 = Referred for evaluation or treatment HEENT 1 2 3 Neurological 1 2 3 Skin 1 2 3 Lungs 1 2 3 Abdomen 1 2 3 Heart 1 2 3 Extremities 1 2 3 Urinary 1 2 3 Vision 1 2 3 Date of Last Tetanus Shot (Required for participation in camp) Record of Past Medical Treatment (including treatment of any chronic/recurring illnesses, surgeries, etc.) Activity Exemptions The camp day includes high activity levels at elevations above 6000 feet. Are there any camp activities from which the camper should be exempted for health reasons? Yes No If yes, please describe: This box must be completed for attendance IF the camper will attend a Camp Wasiu II session lasting 4 nights or longer. Printed name & title of licensed medical personnel Practice / Clinic Name Phone Address Signature Date