Woody Acres Camp

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

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