Medical Forms

REQUIRED MEDICAL FORMS

Thank you in advance for submitting your medical forms as early as possible! We have many licensing requirements to check for each child, and rushing through this process jeopardizes our child care license and puts excess strain on our hard-working staff. Our Summer Camp Director, Heidi Pfeiffer, Ph.D., is happy to answer any questions you may have at heidi@blufflake.org or 414-839-1670.

Standard Medical Forms

ALL SUMMER CAMPERS must submit these two standard forms at least two weeks before your first day of camp. These two forms are NOT currently required for our after school programs. Upload completed forms to your Active registration page, or email them to heidi@blufflake.org. Your doctor’s office could also email them directly to Heidi. *If you do not submit your forms at least two weeks before your child’s first day of camp, you risk the possibility that they will not be allowed to attend. No refunds will be issued for camp days missed due to late forms.

  1. General Health Appraisal Form – Must be a current health appraisal form. It does not need to look exactly like the template. It only needs to state their current health from their last physical. Must be completed and signed by both parent and provider within the past year.
  2. CDPHE Immunization Form – Must be a CDPHE approved immunization that is up-to-date. This template provides an example of the official CDPHE form. Please note that we CANNOT accept immunization records that are simply printouts from your health insurance records.

No additional medical forms are required unless your child has a medical condition. If your child has asthma or an allergy and you will NOT be providing a medication, you must submit a Refusal to Provide Medication Form. If you WILL be providing a medication, please continue to the next section. Please note: when possible, parents are encouraged to administer medication to their child prior to and after camp instead of sending medication to camp.

Additional Medical Forms (If Bringing Medication)

CAMPERS BRINGING ANY MEDICATION must submit all relevant forms from the below list at least two weeks before your first day. This requirement applies to ALL BLUFF LAKE PROGRAMS in which a parent or teacher will not be present the full time, including both summer camp and after school programs.

Forms must be signed in all indicated locations by the provider, parent, and/or camper, dated within the past year. Upload completed forms to your Active registration page, or email them to heidi@blufflake.org. Your doctor’s office could also email them directly to Heidi. If you do not submit these forms at least two weeks before camp, you risk the possibility that we will not be able to accept your child’s medication and/or they will not be allowed to attend. No refunds will be issued for camp days missed due to late forms.

  • Photo of the child’s face – For any medication or medical condition
  • 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
  • Self-Carry Authorization Form – Must be submitted in addition to the above if the medication will be self-carried. Self-carry is currently being approved FOR AFTER SCHOOL ONLY (not summer camp), on a case-by-case basis for campers at least age 10, at the discretion of the Education Manager (Heidi Pfeiffer, heidi@blufflake.org, 414-839-1670).
  • Refusal to Provide Medication Form – Required if: (a) you will not be bringing an over-the-counter antihistamine or second epipen as ordered by the provider on your Medication Orders form; (b) your child has asthma or allergies and you are not bringing any medication; or (c) we cannot accept your medication on the first day of the program because your forms were late or you deviated from the medication drop-off procedure (see below).

Medication Drop-Off Procedure

When you bring your camper’s medication on the first day of the program, 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
  • Correct dose
  • Unexpired for entire camp week
  • If an antihistamine or second epipen are ordered on your care plan, you must either provide them or sign a Refusal to Provide Medication Form for those specific items.

All of the above requirements must be met, or we CANNOT accept the medication on the first day of camp. If that occurs,  your options will be to either: (a) bring your child home with you and return to camp when you have all the required elements; or (b) sign a Refusal to Provide Medication Form and allow your child to stay at camp without medication, at your own risk.  If there is an emergency, we will call 911 and then the parent. No refunds will be issued for camp days missed due to parent deviation from medication drop-off procedure.

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