MEDICATION FORM

For the safety of each camper, all medication, prescription or non-prescription

drugs will be held at the camp First Aid Station and administered by camp-

approved, certified medical personnel, who are on duty 24 hours a day.

If you need to send medication to camp, please put it in a zip-lock bag along with

the completed form below. Be sure to make the form visible through the bag.

Please DO NOT send any medication that is not absolutely necessary.

**All meds must be in the original container.

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PLACE THIS FORM IN THE ZIP-LOCK BAG

ALONG WITH THE MEDICINE

THIS MEDICATION BELONGS TO ___________________________________

CAMPER’SCHURCH_____________________________________________

DOSAGE_______________________________________________________

PARENT’SNAME________________________________________________

DAY PHONE______________________ NIGHT PHONE__________________

DOCTOR’SNAME________________________________________________

DOCTOR’SPHONE_________________________________________