Cocalico School District Health Services Medication Administration for Camp Swatara Experience
Below, please find a copy of the medication permission form for Camp Swatara. One form must be completed for each medication your child is to receive at camp. If you need additional copies, contact the school nurses. If your child will need to take medication during the experience, the following procedures must be used:
All medications and permission forms must be brought to school on the morning of your child’s departure,
even those students who currently have the same medication in school, i.e. inhalers, epi-pens, daily meds.
Only send the number of doses of medication necessary for the camp experience time. All medications must be in the original containers labeled from the pharmacy with the prescribing information. In the case of inhalers, nasal sprays, they must be in the original box with the prescribing information, have an accompanying note from your physician, or a physician’s signature on this form with the dosage information clearly stated. No expired medication will be given.
If it is necessary for your child to take an over the counter medication such as Tylenol, vitamins, Claritin,
herbal or natural supplements, etc., you must have a prescription or note from the physician with the child’s name, dosage and time to be given accompanying the medication. All medications must be in the original containers.
Students are not permitted to keep any medication with them in the camp. An exception to this may be
inhalers and epi-pens with written permission to carry by the parent, physician and school nurse. Students bringing medications to camp without the necessary information and signatures will not receive those medications. If you have any questions concerning medication administration during the environmental experience at Camp Swatara, please feel free to call the health room at your child’s school. Thank you for your assistance in keeping all of our students healthy and safe.
I hereby grant permission for the nurse, or any person authorized by the school, to administer the medication listed below. If a medical necessity arises, the nurse may contact the prescribing professional to discuss this medication. Name of Child
__________ Student is competent to carry and self-administer yes no Rescue Inhalers and epi-pens only
Date _________ __________________________________________________ Student is competent to carry and self-administer yes no Signature of Physician Rescue Inhalers and epi-pens only Physician signature and instructions are required if your child is to carry medication-rescueinhalers or Epi-pens only For Camp Use Only
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