Page 1

Medical Forms Required The following items are required by the Board of Health for our Health Center: 1 Pink Medical form per CAMPER to be completed by your physician each year. 1 Green Medical form and Record of Required Immunizations as indicated on enclosed list. 1 Emergency Care form per FAMILY. This form must be notarized as required by our hospital. This form will be returned to you if it is sent to us without notarization. 1 Meningitis Vaccination Response Form, filled out and signed by parent. 1 Photo COPY of your Medical Insurance Card (front & back) per CAMPER. Do not send the card itself. Or, if your insurance does not have a card, we need 2 Insurance Forms per CAMPER filled out and signed by the policy holder. Do not send forms if you have a card. 1 Photo COPY of your Prescription Card (front & back) per CAMPER if this is separate from your medical insurance card. This is only necessary if you have the coverage. 1 Photo COPY of your Dental Card (front & back) per CAMPER. This is only necessary if you have the coverage. Please send all of the above items to us no later than April 15, 2013 so that we have time to enter the forms, make copies of the emergency information and file all forms before our staff orientation begins. If your appointment with your child’s doctor is after April 15, you can send the Medical Form as soon as your doctor fills it out, but please not after JUNE 1. These forms are all necessary for us to satisfy the Board of Health regulations and, most importantly, to expedite any medical issue that arises with your child.

These must be in place BEFORE your camper comes to camp.

medical-forms-required