. Step 1: medical and emergency form Side 1
. This medical form needs to be completed for ALL CAMPERS and must be on file in the Nurse’s Office prior to the opening of camp. parents of gcdS students must complete Section 1, sign, and date. NO CHILD may start camp until his/her completed form has been received. Section a: Must be
. completed by parent/guardian. Section B: Side 2 of this form must be completed by a physician. Section c:authorization for the adminiStration of medicine form must be completed by a parent/guardian for al children that may require the administration of medication at camp.
. Section a:
. List two persons who would come and care for your child in case of sickness or injury when parents cannot be reached.
. Circle conditions or diseases child has had: Chicken pox Measles Mumps Hives German Measles Scarlet fever
the camp nurse may administer: tylenol Y / N motrin Y / N Benadryl Y / N
. Please note any other facts relating to your child’s health which you feel could be important or helpful to the camp.
. Parent’s authorization and consent to medical treatment: Understanding that my child may need emergency medical treatment during camp or at camp activities while he or she attends the
GCDS Camp, I authorize the Camp, through its nurse or other qualified person, to administer such first aid or other minor medical treatment as shall be deemed best under the circumstances,
and I consent for my child to receive such treatment. I understand that the camp will attempt to notify me (or my spouse) in the event of an emergency requiring immediate medical care for
my child, and if the Camp is unable to notify me, it will have my child treated by a duly qualified physician at the nearest emergency facility. I also understand that neither medical nor accident
insurance is provided by the Camp and that the responsibility for providing such coverage rests with me as a parent or guardian for my child. Signature of parent or guardian responsible for fees
DO NOT RETURN THIS FORM UNTIL Side 2 IS COMPLETED.
medical and emergency form Side 2 Section B: date of initial immunization date of Booster doses
please note history of any of the following diseases or conditions:
Heart Disease, incl. Rheumatic Fever ______________________________________________________________________________________
Neurological Disorders, incl. Epilepsy _____________________________________________________________________________________
Chronic or serious illness ________________________________________________________________________________________________
Birth Defects or injury ___________________________________________________________________________________________________
Speech Difficulty _______________________________________________________________________________________________________
Hearing Difficulty _______________________________________________________________________________________________________
Does the camper wear glasses or contact lenses? ____________________________________________________________________________________________
Scoliosis Examination ______________________________________________________________________________________________ Date ___________________
List any illnesses, injuries, or operations which would assume importance in camp participation: __________________________________________________
List any diet restrictions:_______________________________________________________________________________________________________________________________________________
I have examined this student and found him physically fit to participate in sports and camp activities. This student may be given the non-prescription
medications as needed indicated by the parents: Motrin, Tylenol, and Benadryl. physician Signature mail to: The Greenwich Country Day School
. Step 3: authorization for the adminiStration of medication form
If you wish to have the camp nurse administer your child’s medication during camp hours, you must complete and return this form
along with the medical and emergency forms. Medications must be in the original bottle with the pharmacist’s label. This form must
be renewed annual y. Please bring the medication to the nurse on the first day of camp. only the camp nurse will accept medication. Section c: To be compleTed by parenT/Guardian
I hereby request that the camp nurse (or administrator’s designee) administer medication as prescribed by my child’s physician.
I hereby release The Greenwich Country Day School and its employees from any and al liability arising from the administration of this medication. parent/guardian Signature To be compleTed by physician for every medicaTion
If PRN, signs and symptoms for administering medication
physician Signature self-medicaTion release
Student must be in Grade 9 or older (exceptions are inhaler and Epipen)
physician Signature parent/guardian Signature
Request that (name of camper) _____________________________________________________ be permitted to self-administer the fol owing medication
___________________________________________ at school. He/she has been instructed in and understands the purpose and appropriate method and
frequency of use. He/she wil only be carrying the exact dosage for that camp day on his/her person.
Report to the Heritage Agency of Denmark Merete Sanderhoff, project researcher, Statens Museum for Kunst Image sharing and mobile strategies Research visit at US cultural heritage institutions Pulje 5 – International erfaringsudveksling og kompetencegivende efteruddannelse [International exchange of experience and competence providing training] List of content Field of