* If child has no severe allergy or asthma, please skip to "Restrictions or Adaptations" *
SEVERE ALLERGY: List each medication separate below. All must have pharmacy label!! If needed, TWO Epipens should be brought to camp. The camper must be trained in the use of the Epipen. Camp and staff will assist in administering medication if needed.
ASTHMA: List each medication separately below. All must have the pharmacy label!
** If your camper is not fully immunized you will need to provide a certificate waiver, which can be obtained at your local health department. These forms will need to be mailed, faxed, or emailed to Dahlem prior to attendance.
If your camper needs to take prescription or nonprescription medicine while at Dahlem, the camper’s parent/guardian will need to complete the boxes below. All medication must be in its original container or package, placed in a clear Zip-Loc plastic bag, and clearly labeled. The camper’s name must be printed on the label of all prescription medication. Please be sure to check that medication does not expire before the camper’s last day in our program. If possible, all medications should be given under the supervision of the parent/guardian. When this is not possible, Dahlem Camp Director may give prescribed medication as an assistance to parents/guardians.
** List must include: Name of the Medication, Reason for taking it, When it is given, Dosage, and Date the medication was started
Explain any of the items checked above.
What is the best method for our camp staff to work with your camper?
