Your email Address:
As stated in the Rainbow Camp Policies & Procedures, only authorized Senior Staff (Camp Director or Program Coordinator) or Private Contract Workers will administer - physician authorized prescription medication and non-prescription medication - with Parental/Guardian authorization (i.e. Tylenol, antihistamines, cough syrup, throat lozenges, etc.). ALL medication must be stored in the camp office and in the original container with the camper's name on it. Epi pens and inhalers will be kept with each camper or their counsellor at all times.
I hereby authorize the administration of:
(Medication)
to (Camper name)
by (check one) Senior staff of Rainbow Day Camp OR Private Contract Worker
using the following instructions (include dates, time of administration, special instructions – i.e. 'taken with food'):
Side effects: (stop medication if the following reaction(s) is (are) observed)
Storage instructions for medication: Refridgeration Other:
Name of Prescribing Physician:
Physician Telephone #:
Name of Parent or Guardian:
By checking this box you are signing the document: Date:
