Camp Information Packet - Camp Nesbit

Dear Parents, Guardians, and Troop Leaders,

Welcome to another camp year! Our volunteers are ready to welcome you and offer some new and exciting programs. I feel the lake calling us all back. Camp is a wonderful place to explore nature, learn new things, and gain independence.

Camp Nesbit offers campers opportunities to swim, hike, boat, and try archery. Be sure to read through this packet and bring paperwork with you at camp check-in.

See you at camp!

Quick Facts

Check-in

1:30-3:00 PM EST

Check-out

9:00-10:30 AM EST (see specific schedules in arrival/departure)

Customer Care

888.747.6945 info@gsnwgl.org

Monday-Thursday

8:30 AM – 5:00 PM

Friday

8:00 AM – 12:00 PM

July 7-20

Director: “Stretch”

Kay MacGregor Office: 906.355.2152 azgs3@hotmail.com

Kay “Stretch” MacGregor Camp Director

Please visit gsnwgl.org/camp for more information. Reference

Parent Checklist

□ The final payment is due June 21, 2024 Please mail to: GSNWGL 4693 N Lynndale Drive, Appleton, WI 54913 or call Customer Care at 888.747.6945.

□ Confidential Information Sheet and Camp Nesbit Parent Release form, completed to hand in at check - in .

□ Health History Form signed and dated by parent/guardian. Do not mail. This form is required to be in hand at check- in. Physicals are not required. Immunizations are required and must be current.

□ Provide all necessary items on the packing list.

□ Label all medications and pack them in original containers (your camper must turn these in to the health supervisor upon arrival at camp).

□ Trading post funds (in an envelope) and canteen money ($5.00) should be brought to check-in at camp with the camper's name and amount on each envelope.

□ Campers love "REAL" mail! Camp Nesbit Camper's Name General Delivery Sidnaw, MI 49961

o Bring mail to check-in so campers can get mail while at camp.

Arrival/Departure

Arrival/Check-in

• Check-in starts at 1:30 PM EST on the first day (Sunday) of camp. Check-in as follows:

o K-3rd Grade: 1:30 PM EST

o 4th-6th Grade: 2:00 PM EST

o 7th-12th Grade: 3:00 PM EST

• Families will be checked in together according to the youngest camper's scheduled time.

• Check-in will take place in the parking lot. Parents and guardians will remain in their vehicles during the check-in/drop-off process. You will need to stay within the line of traffic to enter. Please make sure you have used the restroom before camp arrival, no restrooms will be available for use.

• To make the check-in process easy, please have the following items ready, in the following order:

o Camper Release Form and Camper Confidential Information Sheet

o Trading Post Funds (cash, check, Cookie Dough, Fall Bucks, etc. in an envelope marked with the camper's name) and Canteen Money ($5 in a separate envelope with the camper's name).

o Camper Health Form and any medications (in original containers) and Medication Record.  Immunization/Vaccination portion must be completed with dates of vaccinations.

o Your camper will need to step out of the vehicle to have their temperature, head, and feet checked.

o Parents and guardians will help unload their camper's luggage and say goodbye at the vehicle. Camp counselors will take campers to their cabin.

Departure/Check-out

• Check-out is the following Saturday, please arrive according to the following schedule:

o K-3rd Grade: 9:00-9:30 a.m. EST

o 4th-6th Grade: 9:30-10:00 a.m. EST

o 7th-12th Grade: 10:00-10:30 a.m. EST

• A staff member will meet parents and guardians at the entrance to the parking lot. Parents and guardians will need to have their photo ID/driver ' s license available to show and sign their camper' s Camper Release Form. Your camper will be ready for pick-up in the parking lot.

First Day

• After check-in, campers will meet their counselors and move into their cabins. Camper's swimming ability will be evaluated before they can swim at camp. This ensures that campers can safely enjoy their swimming and lake experience. Campers will also participate in fun activities to get to know other campers in their cabin.

Health & Wellness

While we take every precaution at camp, illnesses and injuries can occur. Staff members are trained, at a minimum, in basic First Aid/CPR, but many staff also have higher-level certifications. Our health supervisor is responsible for the well-being of everyone at camp. All visits to the health supervisor are documented parents and guardians will be notified of incidents beyond basic cuts and scrapes.

Health History

The Health History Form (at the end of this packet) needs to be completed within six months prior to your camper's camp session with a copy of their insurance card attached. Campers will not be able to attend camp without this form completed in its entirety. Please DO NOT SEND this form ahead of time it needs to be in hand at check-in for camp. Be sure to report everything that may affect your camper at camp; recent illnesses, injuries, allergies, etc. Omitting items does not help camp staff correctly care for your camper while they're at camp. The vaccination section of the form MUST be filled out with dates. Writing "up to date" will not be accepted.

If your child has special health needs, please contact the camp director at least two weeks before their camp program This will help us ensure your camper has a great experience and allow us to serve your child better

Medication

By law, all medications (prescription, over the counter, homeopathic, topical ointments, and vitamins) must be collected upon check-in by the health supervisor. The health supervisor may only dispense medications listed on the health profile, so please note all medications that your camper brings to camp

• Keep medications in the original containers this includes inhalers, epi-pens, vitamins, etc., which identify them as your camper's medication, the instructions for dispensing, etc. Put all medications in a zip-lock bag with your camper's name. Medications that are not in their original containers will NOT be dispensed.

• Medication labels must match health profiles and must be current. Expired medications will not be accepted.

• Campers may not keep any medication in their possession.

• The health supervisor will keep medications, vitamins, ointments, etc., in a locked box during camp.

• Inhalers, bee sting kits, and other necessary items will be kept with campers/staff as determined by the health supervisor and noted on the health profile.

• If your child has specific health needs (injections, specialized equipment, dietary concerns), please contact the camp director before your camper's session so our staff can prepare to meet their needs.

• Due to allergies, please DO NOT send essential oils to camp with your camper.

The health supervisor will ensure that your camper receives their medication. Like those required for allergies, emergency medications are kept close at hand inside a red bum bag attached to camper's backpacks.

NOTE: If your camper is not taking prescribed medication while at camp, you MUST still inform the camp staff of your camper's condition.

Illness, Communicable Disease, Lice

Do not send your child to camp if they have been exposed to a communicable disease or if they are ill. Parents must check their children for COVID-19, communicable diseases, and lice before they come to camp. Camp Nesbit has a no-nit policy. We will not allow anyone with lice or nits to remain at camp. Everyone is screened upon arrival; any child with lice, nits, COVID-19 symptoms, or any communicable disease will need to leave camp. If head lice have been detected, the camper will be sent home, and they cannot return until 24 hours after treatment is complete. We will expect the parent/guardian to pick up the camper as soon as possible.

Emergency Contacts

Make sure that you or your camper's emergency contacts will be available while your child is at camp. Reasons camp staff would contact you include but are not limited to the following:

• Homesickness that is getting worse or not better.

• Conduct by your child that is inappropriate at Girl Scout camp.

• Illness or injury to your child that requires a stay in the health center for an extended period of time, requires medical attention outside of the camp health services or requires your child to leave camp.

Vaccinations

Girl Scouts of the Northwestern Great Lakes requires campers to comply with the recommended childhood immunization schedule published annually by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians before attending their camp session. Partial immunization is not accepted. For more information on the vaccination schedule visit: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

GSNWGL supports medical exemptions to specific immunizations for each camper (e.g., congenital conditions, compromised immune systems, or taking specific medications) when accompanied by a physician's note. Nonmedical exemptions to required immunizations are not accepted. Girl Scout health and safety are always first and foremost. Immunization requirements for participation provide a safe environment for all.

Camp & Illness

We continue to follow the guidance of the CDC, American Academy of Pediatrics, American Camp Association, and local health experts in managing Girl Scout Camp most safely. Please help us provide a safe and healthy experience for campers, staff, and families by mitigating risk before arriving at camp, limiting the chance of exposure to illness whenever possible. Review our Screening and Illness guide before arriving at camp.

Pre - Camp Health Screening

Please screen campers for any illnesses prior to camp arrival. If your camper has any symptoms like fever or rash, please notify camp staff and keep your camper at home.

Housing & O perations

Each cabin will house up to 10 campers & 2 staff. Campers have a space to keep belongings and will be expected to keep personal belongings tidy. Regular showering and changing of clothing is expected within the camp schedule. Supplies to clean the cabin each day will be supplied. Please send a bag to contain camper's dirty laundry (no onsite laundry facilities).

Camp Health Center

Our camp medical staff has a space to house campers for short stays if ill. If your camper requires longer stay for sickness, you will be contacted to pick up your campe r

Camp staff will help campers adjust to camp life. Campers are expected to follow the Girl Scout Promise and Girl Scout Law while at camp. Council policy states that campers and adults may not use weapons, alcohol, unprescribed drugs, or tobacco products, including e-cigarettes and vaporizers, etc., at Girl Scout functions or on Girl Scout property. Pets and animals are not allowed to be brought onto the camp property.

If a situation arises, every effort will be made to correct the issue and ensure a positive camping experience for all campers. Camp Nesbit reserves the right to send home anyone who consistently exhibits inappropriate behavior, endangers the camp community or whose actions tow ards others are unacceptable. This is at the expense of the parent/guardian; we will not grant a refund of session fees.

The following are the expectations of all campers:

Behavior Homesickness

• Respect and cooperate with campers and counselors in your unit and throughout camp. Make an effort to get to know campers in your unit and find ways to include everyone.

• Tell a counselor about any problems at camp. It's okay to tell if you (or someone you care about) are having trouble getting along with another camper, are frightened, don't feel well, or miss your family.

• Disagreements at camp will be settled by talking through the problem. Adults at camp will help campers discuss their differences and find solutions.

• Offensive or abusive language is not permitted.

• Physical threats, physical violence, aggressive behavior, destructive behavior, or threats of destructive behavior will be taken seriously and not tolerated.

• Self-destructive or abusive threats or actions will be taken seriously.

• Harassment and teasing of other campers will not be tolerated.

It is natural for children to experience homesickness while away from home and their routine. Talk to your camper about some of the things that will be different. Prepare campers to expect to compromise with other campers, help with clean -up, and share the counselor's attention. Talk about all the great things that will happen at camp: making new friends, learning new skills, and having fun. Do not make promises that they can go home whenever they want. DO NOT send along a personal cell phone to contact you whenever they want.

Please encourage your camper to have the confidence to enjoy the experiences at camp and have the courage to be open to new friends and activities. Most importantly, talk to them about how excited you are for them to go to Girl Scout camp and all the fun they will have. Do not tell them how sad you will be without them and how much you will miss them. While this is okay to do in a small amount, it only makes them think about how sad you are without them and that they might be missing out on something at home, making them more homesick.

The following are researched suggestions from camping professionals at the American Camp Association: Before Camp:

• Kids are more likely to have a positive experience if you prepare for camp together.

• Pack their favorite stuffed animal.

• Practice nights away from home before coming to camp.

• Do not tell your child that you will 'rescue' them from camp. Don't bribe —the reward will be selfconfidence and independence. Don't tell your camper they can call you or that you will call them. These promises only increase homesickness since that becomes all a homesick child can think about.

• Acknowledge you will miss them, but reinforce that you know they will have fun and be safe at camp.

• Ask your child if they think they will get homesick.

• Acknowledge their feelings regarding camp before they leave.

• Let them know things at home will be taken care of—pets will be fed, etc. It's tough for kids to feel worried or guilty for being away from home. During camp:

• Avoid the temptation to pick up your child early.

• Don't feel guilty about encouraging your child to stay at camp.

• Trust your instincts; most homesick incidents will pass.

Life at Camp

Every camper who channels their wild side at camp will get to shoot archery, learn team-building skills, play games, learn about nature, make art, and swim in the lake how they do each is up to them and their fellow campers!

Keep in Contact

Everyone loves to get mail at camp! Some campers write often, and others not at all. Your camper would LOVE to hear from you! You can bring packages (no food or snacks) and letters for your camper on check-in day or mail the first letter a day or two before the session begins. Please allow time for mail to arrive within her session. You may receive a letter after your camper's arrival back home. Late mail will be returned to the sender.

Mail should be addressed to:

Camp Nesbit - Camper's Name General Delivery Sidnaw, MI 49961

To ensure your camper can mail letters home, please send addressed and stamped envelopes with them to camp. Do's and don'ts of letter writing

• DO tell your camper how much you love them.

• DO tell your camper you hope they are having fun and that you can't wait to see them!

• DO ask questions about their cabin mates, swimming, favorite counselors, etc.

• DON'T tell them bad news such as family illness or the death of a pet.

Telephone

The phone line at Camp Nesbit is for business purposes only. Campers cannot make or receive calls while at camp. Please do not send a phone or smartwatch with call/text abilities to camp they will be held in the camp office until the end of the week. Devices distract from the camp experience and create homesickness problems for the entire group. Help us provide a healthy team environment and leave devices at home.

Trading Post & Canteen

Want to take your camp love home with you? Our trading posts are filled with toys, cuddly buddies, cozy shirts, tie-dye swags, jewelry, goodies, and more! Trading posts will be stocked with the latest in summer fun, so send your camper with a few extra dollars in their pocket to spend at the trading post. Please put money in an envelope marked with your camper's name and turn it in at check-in. You can leave money for the trading post when you drop your camper off, in any dollar amount you choose.

Please note, that after your camper's time at camp, any unused trading post funds will be refunded in cash and sent home with your camper. Fall Bucks and Cookie Dough can also be used at the trading post—campers must come with their Cookie Dough and Fall Bucks information to redeem it. Unused Cookie Dough and Fall Bucks will be returned. Online Cookie Dough and Fall Bucks CAN NOT be used at the camp Trading Post.

Campers have a chance to go to the Canteen (snack shop) daily to purchase a snack or drink. Campers are limited to two $.50 items each day. Please put only $5.00 in an envelope with your camper' s name on it for the Canteen.

Laundry Facilities

Camp Nesbit does not have laundry facilities available for troop/camper use. On the health profile, please indicate if your camper is a bed-wetter (which is not unusual and nothing to be worried about). Your camper should talk with their counselor or another staff person with whom they feel comfortable if they have an accident. Our health supervisor will launder items (bedding & clothing) and put them back as discreetly as possible.

Lost or Damaged Items

Camp Nesbit, and Girl Scouts of the Northwestern Great Lakes are not responsible for the loss or damage to a camper's personal belongings. Campers should not bring personal equipment to camp without the prior approval of the camp director. Campers cannot bring curling irons, straighteners, hairdryers, radios, portable DVD players, iPods, iPads, tablets, cell phones, video games, animals or pets, weapons, or vehicles. Please label all items brought to camp with your camper's first and last name. All lost and found items will be donated to charity at the end of the camp season. Our lost and found will be kept in the dining hall. Please be sure to check there before you leave camp.

Packing List

PLEASE LABEL ALL ITEMS WITH YOUR CAMPER'S FIRST AND LAST NAME.

Required items at check-in—to be handed to troop leader

□ Completed Health History Form with an attached copy of insurance card

□ Medications in the original container in a zip-lock with their name on it.

□ Completed Camper Release Form, Confidentiality Sheet, and Medication Record Form .

□ Money for the trading post and canteen.

o Please place money in separate envelopes with the amount and your camper's name.

Clothing

□ Raingear (raincoat, boots)

□ Jacket or sweatshirt (2)

□ Swimsuit (2 for water sessions)

□ Warm pajamas

□ Tennis shoes (2 pairs)

□ T-shirts (1 per day)

□ Shorts (1 per day)

Personal Items

□ Beach towel

□ Bath towel & washcloth

□ Shower shoes (flip flops)

□ Soap or body wash (unscented)

□ Shampoo & conditioner

□ Toothbrush & toothpaste

□ Deodorant

□ Long-sleeved shirts (2 per week)

□ Jeans or long pants (2 per week)

□ Underwear (1 pair per day + extras)

□ Socks (1 pair per day + extras)

□ Hat or bandana & sunglasses

Do Not Bring

• Cell phones, radios, MP3 players

• Electronic games or appliances

• Aerosol spray cans

Packing Tips for Campers

□ Sunscreen & lip balm

□ Non-aerosol insect repellant

□ Comb or brush

□ Tissues

□ Hair ties or headbands

□ Other personal toiletries

• Food or snacks

• Makeup

• Dangle/hoop jewelry

Equipment

□ Sleeping bag or blankets

□ Pillow with pillowcase

□ Flashlight (new + extra batteries)

□ Water bottle

□ Backpack & laundry bag

Optional Items

□ White shirt (or item for tie-dyeing)

□ Notes for home (stamped & addressed)

□ Quiet games or books

□ Journal, pens, pencils

Pack clothing/equipment into one duffel bag, tote, backpack, or old suitcase your camper can carry. Campers should help pack their gear to know what they bring to camp. Put the camper's name on ALL their clothing and personal items. Use nametags or a laundry marker. If you bring a laundry bag, please label that bag.

The packing checklist is for your convenience. Avoid unnecessary purchases. If you can substitute something on the list with an item you already have, feel free to do so. Remember, campers will be outdoors most of the time and need clothing suitable for warm days and cool mornings/evenings and rain. Leave anything of value at home. We cannot be responsible for missing articles or items ruined while at camp.

Change, Cancellation, and Refund Policy

6+ weeks in advance full refund, less camp deposit; deposit may be transferred to a different session. 3-6 weeks in advance 50% refund.

Refunds are not issued for cancellations within three weeks of your camp session. Exceptions for extenuating circumstances, providing documentation of family emergency or health condition, may be considered. Refunds will not be made if a participant is sent home due to homesickness, misconduct, or parent request. If a participant is sent home, a parent or guardian handles and pays for transportation.

From Green Bay/south:

Camp Nesbit

Sidnaw, MI 49961

• It is approximately 170 miles from Green Bay to Sidnaw.

• Follow US Hwy 141 N to Michigan border.

• Follow 141 N until you reach M-28

• Take a left on M-28, and follow to the town of Sidnaw (about 8-10 miles).

• You will see a sign for Camp Nesbit, take a right.

• Turn left at the next Nesbit sign you see. If you hit the dirt road you have gone too far.

• Take a right at the gate, 1.7 miles past the previous sign.

From eastern U.P.:

• If taking M-28:

o Follow M-28 west to US 41 split; take a left and follow M-28 to Sidnaw.

o You will see a sign for Camp Nesbit, take a left.

o Turn left at the next Nesbit sign you see.

o Take a right at the gate, 1.7 miles past the previous sign.

• If taking US 2:

o Take US 2 west to Crystal Falls, turn north on US 141 to the M-28 intersection.

o Turn left and travel west on M-28 to Sidnaw.

o You will see a sign for Camp Nesbit, take a right.

o Turn left at the next Nesbit sign you see.

o Take a right at the gate, 1.7 miles past the previous sign.

From western U.P.:

• Take M-28 east to Sidnaw.

• Take a right at the sign for Camp Nesbit.

• Turn left at the next Nesbit sign you see.

• Take a right at the gate, 1.7 miles past the previous sign.

You may choose to use a navigation app to get directions from other start points. If you do, use Sidnaw, MI as your town destination and follow the final directions to camp noted above. If you get lost on the way, you may call camp at 906.355.2152.

Confidential Information Sheet

The counselors at Camp Nesbit will be responsible for your camper during their stay at camp this summer and want to know about them before they arrive. Your expectations and your camper's wishes are important and necessary for us to be aware of so that they have a positive experience.

Please complete this form and turn it in at check - in.

Camper's name: _________________________________________________________________ Age:

Program name: Dates attending:

My camper is most excited to experience:

Does your camper have any fears? ☐ No ☐ Yes, please explain:

Check all that apply.

My camper: ☐ Sleepwalks ☐ Has nightmares ☐ Wets the bed ☐ Other: ____

If you checked any of the above, how do you handle these situations?

Has your camper's menstrual period started? ☐ Yes ☐ No If not, are they prepared for this should it start? ☐ Yes ☐ No

Is this your camper's first extended period of time away from home? ☐ Yes ☐ No If yes, describe your positive approaches of encouragement so we can reinforce them if necessary.

Has your camper experienced homesickness, or are you concerned that they may experience it at camp? ☐ Yes ☐ No

If yes, please list what we can do to help them while at camp.

Does your camper have skills or talents they would like to share at camp? ☐ Yes ☐ No

Please share any additional information or needs so we can make the camp experience a positive one. (continue on back)

Camp Nesbit Parent Release Form

Dear Parent or Guardian,

This form is used as a security measure and protection for your camper's well-being. We want to make sure only authorized individuals pick up your camper.

Please complete this form and turn it in at check - in.

Camperswillnotbeallowedtoleavewithanyoneotherthantheauthorizedindividualslistedbelow.

Individuals picking up campers will be asked to present photo identification. Be sure to include both parents' names if it is okay for either one to pick up your child.

YOU registered this camper. Therefore, this form has been sent to you and only you can use it.

Program name: __________________________________________________ Dates attending:

My camper (print full name), _____________________________________________________, has my permission to leave camp with the following individuals:

NAME: RELATIONSHIP TO CAMPER:

Signature of Parent/Guardian

Printed Name of Parent/Guardian:

Date:

Girl Information

Troop #: Individual: ☐ Service Unit:

Camp Health History Form

Please print clearly in ink This form should be completed for ALL campers.

First Name: Middle Name: Last Name:

Mailing Address: Apt. # PO Box: City: State: Zip:

Phone: ( ) Email:

Parent/Guardian

Information

Parent/Guardian Name (1):

Mailing Address: Apt. #

City: State: Zip:

Phone: ( )

Cell Phone: ( ) Email:

Parent/Guardian Name (2):

Mailing Address:

City: State: Zip:

Phone: ( )

Cell Phone: ( ) Email:

Custodial Care Information: ☐ Both Parents ☐ Mother Only ☐ Father Only ☐ Other: ________

Health Information

Name of Family Physician: Phone: ( )

Family Medical Insurance Carrier: Policy or Group No:

Family Dental Insurance Carrier: Policy or Group No:

Health Information | Age: Date of Birth: / / Immunization Record ("up to date" will not be accepted )

Which of the following have you had?

Measles ☐ Chicken Pox ☐ German Measles

Please give all dates of immunizations

Vaccine:

DTP

TD (Tetanus Diphtheria)

Tetanus

Polio

MMR OR Measles OR Mumps OR Rubella

Haemophilus Influenzae B

Hepatitis B

Varicella (Chicken Pox)

COVID- 19

Date of last health examination: / /

Were there any medical problems at the time? ☐ No ☐ Yes If yes, please explain:

Does the participant have any physical, mental, or psychological conditions requiring medication, treatment, or other special restrictions or considerations? ☐ No ☐ Yes

If yes, please state the restriction/consideration and reason:

Does the participant take any prescribed medications or over-the-counter drugs on a regular basis? ☐ No ☐ Yes

Please fill in the parent section of the medication record form that is provided.

List any prescription or over-the-counter medications your camper will be bringing to camp.

*All prescriptions MUST be in their original container*

We can only administer prescription medication according to directions on the label unless we have a signed doctor's note.

Over-the-counter medications | We have the following over-the-counter medications at camp. Check all items that we may give your camper if they should need medication. All medications are given based on your individual child's weight or age as listed in the instructions.

☐ Acetaminophen (such as Tylenol or other non-aspirin pain relievers)

☐ Ibuprofen (Motrin, Advil)

☐ Throat lozenges

☐ Antihistamine (such as Benadryl)

☐ Calamine, Caladryl, or other anti-itch lotion

☐ Antibiotic ointment (such as Polysporin or Neosporin)

☐ Hydrocortisone cream

☐ Antacid (Tums)

☐ Antifungal ointment or spray (for athlete's foot)

☐ Sunscreen (SPF 30 max)

☐ Bug spray (10% deet max)

Comments:

Is the participant restricted or limited from participating in any physical activity? ☐ No ☐ Yes If yes, please explain:

Please provide a record of past medical treatment, if any, including injuries or surgeries:

Participant has the following health conditions/allergies/dietary restrictions (food and medications): ☐ ADHD ☐ Asthma

☐ Allergies (specify) _______

Diabetes

Headaches

Emergency Contact (non-parent)

Seizures

Other_______________________________

First Name: Last Name: Relationship: Phone: ( ) Cell Phone: ( )

Parent/Guardian Authorization | This health form is complete and accurate. I know of no reason(s), other than the information indicated on this form, for why my child/camper should not participate in the prescribed activities, including field trips, except as noted. In the event that my child/camper needs medical attention while participating in Girl Scout activities, I authorize the adult in charge to see that my child/camper receives routine healthcare, medications, and reasonable first aid, and transport my child/camper to a health care facility for emergency services as needed. I give permission to take photographs and/or videos of my camper for publicity purposes.

Parent/Guardian Signature: Date:

Adult Member Authorization | This health form is complete and accurate. I am able to engage in all prescribed activities as noted. I give permission to take photographs and/or videos for publicity purposes.

Adult Member Signature: _________________________________________________________ Date: ______________________

Camp Nesbit Medication Record Form

Camper's name: _________________________________________________________________ Age:

Program

Medication |

Dose, Route, Frequency (Parent lists medication to be given)

to be given

First Aider/Health Officer initial and note time medication is given