2021 SUMMER CAMP MEDICAL FORMS
REQUIRED MEDICAL FORMS AND INFORMATION
Thank you in advance for submitting your medical forms as early as possible! We have many licensing requirements to check for each child and rushing through this process jeopardizes our childcare license and puts excess strain on our hard-working staff. Our Summer Camp Director, Martina Pfender is happy to answer any questions you may have at firstname.lastname@example.org.
Standard Medical Forms
ALL SUMMER CAMPERS must submit the CDPHE Immunization Form before your first day of camp. You may email them to email@example.com. Your doctor’s office could also email them directly to firstname.lastname@example.org.
- Certificate_of_Immunization– Must be a CDPHE approved immunization that is up-to-date. This template provides an example of the official CDPHE form. Please note that we CANNOT accept immunization records that are simply printouts from your health insurance records.
No additional medical forms are required unless your child has a medical condition. If your child has asthma or an allergy and you will NOT be providing a medication, you must submit a Refusal to Provide Medication Form If you WILL be providing a medication, please continue to the next section. Please note: when possible, parents are encouraged to administer medication to their child prior to and after camp instead of sending medication to camp.
Additional Medical Forms (If Bringing Medication)
CAMPERS BRINGING ANY MEDICATION must submit all relevant forms from the below before your first day.
Forms must be signed in all indicated locations by the provider, parent, and/or camper, dated within the past year. Email them to email@example.com. Your doctor’s office could also email them directly to firstname.lastname@example.org.
- Asthma Care Plan & Medication Orders – For inhaler
- Allergy & Anaphylaxis Emergency Care Plan & Medication Orders – For EpiPen (with or without antihistamine)
- Medication Administration Permission Form – For any other medication
- Refusal to Provide Medication Form– Required if: (a) you will not be bringing an over-the-counter antihistamine or second EpiPen as ordered by the provider on your Medication Orders form; (b) your child has asthma or allergies and you are not bringing any medication; or (c) we cannot accept your medication on the first day of the program because your forms were late or you deviated from the medication drop-off procedure (see below).
Medication Drop-Off Procedure
When you bring your camper’s medication on the first day of the program, please plan to spend about 5 minutes talking with the counselor who accepts them. We will need to check to make sure all these requirements have been met before we can accept the medication:
- Original packaging
- Child’s name on the package (write it on with permanent marker for over-the-counter medications)
- Correct brand or generic variety
- Correct dose
- Unexpired for entire camp week
- If an antihistamine or second EpiPen are ordered on your care plan, you must either provide them or sign a Refusal to Provide Medication Form for those specific items.
All of the above requirements must be met, or we CANNOT accept the medication on the first day of camp. If that occurs, your options will be to either: (a) bring your child home with you and return to camp when you have all the required elements, or (b) sign a Refusal to Provide Medication Form and allow your child to stay at camp without medication, at your own risk. If there is an emergency, we will call 911 and then the parent. No refunds will be issued for camp days missed due to parent deviation from the medication drop-off procedure.