Supplemental Medication Forms

Supplemental Medication Forms for Summer Camp

IF BRINGING A MEDICATION TO CAMP, please carefully follow the three steps below. Please note that the deadline for your form(s) is two weeks before your first day of camp!  Please email completed forms to maggie@blufflake.org.

  1. See your child’s doctor to have the correct form(s) completed

Please locate and download your correct form(s). Please note they must be completed and signed by the health care provider and the parent within the past year.

Asthma Care Plan & Medication Orders

For inhaler

Allergy & Anaphylaxis Emergency Care Plan & Medication Orders

For epipen (with or without antihistamine)

Medication Administration Permission Form

For any other medication

Refusal to Provide Medication Form

You will be asked to sign this before leaving your child at camp if either:

(a) You do not bring an antihistamine or second epipen that is ordered on your Allergy & Anaphylaxis Care Plan; or

(b) We cannot accept your medications due to late forms or instructions not being followed.

2. Submit your form(s) at least two weeks before camp

Please email your completed forms to maggie@blufflake.org at least 2 weeks before your child’s first day of camp. If we do not receive your forms by the deadline, you risk your medications not being accepted on the first day of camp. You will not receive a refund if your child leaves camp for this reason.

3. Follow All Instructions for Medication Drop-Off

When you bring your camper’s medication on the first day of camp, please plan to spend about 5 minutes talking with the counselor who accepts them. We will need to check to make sure all these requirements have been met before we can accept the medication:

  • Original packaging
  • Child’s name on package (write it on with permanent marker for over-the-counter medications)
  • Correct brand or generic variety (list of common generic items coming soon)
  • Correct dose
  • Unexpired for entire camp week
  • If they are ordered on your care plan, you must bring the antihistamine and second epipen, or sign a Refusal to Provide Medication Form  for those items.

What Happens if You Cannot Accept My Medication?

If your forms are late or you do not follow all the instructions for medication drop-off, you risk the possibility that we will not be able to accept your medication on the first day of camp. If this occurs, you have two options:

(a) Do not attend camp until we have all the needed forms and are able to accept the medication. You will NOT receive a refund for any camp days missed.

(b) Sign a Refusal to Provide Medication Form  for any medications that we cannot accept. Your child can stay at camp at your own risk, but we CANNOT accept or administer the medication. If there is an emergency, we will call 911 and then the parent.

Please contact maggie@blufflake.org with any questions or concerns.