• Camper Medical Information

    Rainbow's End Day Camp
  • Camper's Date of Birth*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Drug Allergies*
  • Non-Drug Allergies*
  • Are there any concerns with the following? If yes, please explain:
    Rows
  • Any history of the following? If yes, please explain:
    Rows
  • Does camper have seizures or convulsions?*
  • Date of last seizure
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current health conditions requiring medication, treatment or special consideration while at camp
  • Will camper be receiving medication while at camp?*
  • If yes, please fill in the medication information below*
  • May this camper be given any of the following if the need arises? (Medication is not provided by the camp and would need to be brought to camp by the camper.)
    Rows
  • Date of Signature*
     / /
    2 digit month, 2 digit day, 4 digit year

  • When camper arrives at camp, the nurse will collect all medications. All prescription medication must be in its’ original container with the name of the medication, dosage, Pharmacy name, Physician’s name, and time medication is to be taken. Any over the counter medication must be in its’ original package with campers name on it. Any unused medication will be returned at the end of the week.

  • Should be Empty: