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Required Medical Forms for Attendance at a Residential Camp

As part of your child’s attendance at this summer Residential Camp, there are some important medical forms that you are required to submit at check-in.  Please download these forms below and complete accordingly.

Note:  Due to strict department of health regulations, we cannot permit any child on camp until these completed documents are submitted to the Camp Health Director.

 

Form 1:  Prescription and Over the Counter Medication Form

If your child will be taking medication while at camp, it is state law to secure your consent for medication distribution and for the use of medical devices. In addition to your consent, the prescribing physician must provide sign off on all medications, including over-the-counter medications, to be used at camp. Campers are NOT ALLOWED to hold onto medication while at camp. ALL medications must be submitted with this accompanying document to the Health Director of the camp for proper storage and administration. Prescription medications must be in their original containers bearing the pharmacy label and have specific instructions for use (Child’s name, dosage, # pills inside, prescribing practitioner, pharmacy name & address, filler's initials, serial #).

Important:  Due to Department of Health Regulations we cannot accept completed forms which read “as needed”, they must have a specific dosage 

Note:  If your child won’t be taking medication, you are still required to complete and sign page 1 of this form.  

DOWNLOAD FORM HERE

 

Form 2: Health Screening Check-in Form

At check-in, parents are required to submit a Health Screening Form which can be downloaded below. As the health history or medication needs of a camper may have changed from when the online registration form was completed, we do a follow up check to see if there are any new health concerns, injuries or illnesses that we should be aware of.

DOWNLOAD FORM HERE

 

Form 3: Immunization Records

At check-in, parents are required to submit a record of your child’s current immunization history, for your convince a standard form is provided at the link below, it does not require a doctors signature, additionally we also accept copies of your child’s doctors provided form.   Immunization dates are required for diphtheria, haemophilus influenza type B, hepatitis B, measles, mumps, poliomyelitis, rubella, tetanus and varicella (chicken pox),or acceptable exception notification. If a child has not received immunizations due to a bona fide religious objection, it must be stated on this form.

DOWNLOAD FORM HERE

 

Form 4: Health History Form 

Every child attending a residential camp is required to submit a Health History Form.  The form provides the past medical history, any allergies and any medications (please note the medication policy on the form). 

DOWNLOAD FORM HERE

 

Form 5: Health Examination Form  (SUNY Maritime Camp Only  - NYC health requirement)

Every child attending a NYC overnight camp is required to submit a Health Examination Form completed by a licensed physician within one year of the camp start date. Such record shall include a signed statement containing a summary of the results of the examination, the past medical history and, if a disease or abnormal condition is found, recommendations for exclusion or treatment of the child, or modification of his activities. If there is a bona fide religious objection to physical examination, there shall be submitted a written statement signed by parents or legal guardian to the effect that such child is in good health and that they assume the health responsibility for the child while in camp with the understanding they will be notified immediately if anything unforeseen occurs. The following Health Examination Form is provided as a template, campers can submit this version or an equivalent form which contains the same information.  Campers submitting this form are NOT required to submit a separate immunization form, providing that immunization details are included on the Health Exam Form. 

DOWNLOAD FORM HERE

 

Additionally, for NY camps please take some time to read the attached informational pamphlet provided by the NY State Department of health (NY Overnight camps have a permit to operate from the New York State Department of Health)

DOWNLOAD FORM HERE

 

 

 

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