Demo Form 2 Woody Acres - Medications Parent / Guardian Name Parent / Guardian Email Campers Name Medications Medications include vitamins and natural remedies. This camper will NOT take any daily medications while attending camp. This camper WILL take the following medications while attending camp. Name of 1st Medication Reason for taking 1st Medication When 1st Medication is given. Breakfast Lunch Supper Bed time Other time Indicate Other Time 1st medication is given. Amount or Dose given. Name of 2nd Medication Reason for taking 2nd Medication When 2nd Medication is given. Breakfast Lunch Supper Bed time Other time Indicate Other time when 2nd Medication is given. Amount or Dose given. Name of 3rd Medication Reason for taking 3rd medication When 3rd medication is given. Breakfast Lunch Supper Bed time Other time Indicate Other time 3rd Medication is given. Amount or Dose given. Name of 4th Medication. Reason for taking 4th medication. When 4th medication is given. Breakfast Lunch Supper Bed time Other time Indicate Other time 4th medication is given. Amount or Dose given Name of 5th Medication Reason for taking 5th Medication When 5th medication is given Breakfast Lunch Supper Bed time Other time Indicate Other time 5th medication is given. Amount or Dose given. By checking this box, hereby grant permission to the camp medical staff member or designate to administer the above listed prescription or non-prescription medications. We are providing you a list of the medications that MAY be used in the nurse’s station. We request that you review them and check the ones that you would approve for us to use for your child should he/she become ill. Cold Medications Advil Cold and Sinus Cough drops (Various brands) Throat lozenges (Various brands) Benalyn Cough Syrup Head Ache / Fever / Pain Tylenol (generic/other brand) Ibuprofen / Motrin / Advil (generic) Nausea / Vomiting Pepto-Bismol Gravol (or generic / other brand) Gravol (ginger-natural ingredients) Constipation Ex-lax Colace Dulcolax Natural Remedies Oil of Oregano (cold/flu) Charcoal (nausea/diarrhea) Oil of Oregano (topical of infection) Charcoal (topical for infection) Other essential Oils Allergies Benadryl Claritin Reactin Epinephrine (Epi-Pen) - anaphylaxis reaction only Wounds Alcohol Polysporin H2O2 Peroxide Saline Povidone / Iodine Diarrhea Pepto-Bismol Imodium Topical After bite Mosquito spray Sunscreen Calamine lotion Solarcaine Aloe Vera Epsom Salts (soak for infection) Head lice medication (any brand) All Allergies Other Comments: By checking this box, I hereby grant permission to the camp medical staff member or designate to administer the above listed prescription or non-prescription medications. Human Check 0 + 6 = When this form is submitted you will be redirected to the Woody Acres Camp - Payment Options page.
