1. 2018 Sedgwick Science Camp Forms:
Student Registration and Health Form (front of pink form)
Authorization to Administer Medication
(back of pink form) *
Special Dietary Needs Form (front of blue form)
Allergy and Anaphylaxis Action Plan (back of blue form)*
*requires doctor signature and clinic stamp
How to turn in medication
Prescription ( original box, pharmacy label attached)
OTC (new, sealed, in box, with dosing device)
Nurse office hours to check meds
Important dates

2. 2018 Sedgwick Science Camp Student information Parent information
Need 24/7 phone number
Insurance Info
ie:
Kaiser, Blue Cross etc
Emergency Contact not parent

3. 2018 Sedgwick Science Camp Ok to film student Check box
HEALTH INFORMATION
Check all boxes that apply
(stings-if never stung write never)
Write explanation for all checked boxes
Does your student take ANY medication?
Including over the counter
Don’t forget to sign

4. 2018 Sedgwick Science Camp Camp Provided over the counter medications
No need to pack
If yes to ALL meds mark Yes
If yes to some and no to others
Mark yes, cross out meds not able to take
If No to ALL meds mark NO

5. 2018 Sedgwick Science Camp EEmergency Medications only
Physician completes this section
EEmergency Medications only
((A(Epipens and asthma inhalers)
Does student have permision to carry and self administer as needed?
Yes check YES
No check NO
Write all meds to be given—Dr. write as if prescription
Med
Dose
Route
Time
Condition
If as needed must have frequency
(as needed every 4 hours)
Doctor’s signature and office stamp

6. 2018 Sedgwick Science Camp
Don’t forget to sign

7. 2018 Sedgwick Science Camp Circle foods student does not eat
(does not include picky eaters)
fIf Student Allergic complete entire form
If medication listed you must complete medication authorization form (back of pink form) and Allergy Action Plan (back of blue form)
How is allergy triggered?
Ingestion
Contact
inhalation

8. IMPORTANT INFORMATION
2018 Sedgwick Science Camp
Yes to epipen then complete Medication Authorization form (back of pink form) and Allergy Action Plan (back of blue form)
IMPORTANT INFORMATION
IF STUDENT ALLERGIC TO
EGG
SOY OR
CORN
CALL (
2 WEEKS PRIOR TO CAMP

9. 2018 Sedgwick Science Camp Physician completes form
Student information
What medication for which symptoms
What are they allergic to
Antihistamine:
Write as prescription
Medication
Dosage
Route
Time
If as needed include frequency
Circle dosage for epipen

10. 2018 Sedgwick Science Camp Physician information
Signature and Office stamp

11. 2018 Sedgwick Science Camp

12. 2018 Sedgwick Science Camp

13. 2018 Sedgwick Science Camp
Student can not turn in medication bags. Parents MUST turn in medication to health office. Medicaiton will not be accepted from students.

14. Important Dates to remember
2018 Sedgwick Science Camp
Important Dates to remember
February 26, 2018 Turn in Camp forms to teacher
March 26, 2018 Parents turn in medication bags
March 26 9:00am-10:30am Medication office hours with Julie Low RN
March 27, 9:00am-10:30am Medication office hours with Julie Low RN
March 28, 9:00am-10:30am Medication office hours with Julie Low RN
April 27, 2018 Final day medication bags will be accepted
May 21, 2018 Board bus to go to camp
May 24, 2018Pick up student and belonging at Sedgwick

15. Freguenly Asked Questions:
2018 Sedgwick Science Camp
Freguenly Asked Questions:
Who do I contact with questions
Medical or Medication questions—Julie Low
General camp questions—Your child’s teacher
Can I use the medication already at school
Yes—you must contact Julie Low and make arrangements