Instructions for Administering Medication
Please send this form with the Camper
Full Name of Camper:
Name, cell phone and email address of primary contact for questions relating to camper’s medication:
Cell phone number:
Name of camper’s primary physician:
Medications taken daily:
Please indicate the name of the medication with dosage, number of pills, and time medicine should be given.
Special instruction for any of the medications listed?
Medications to be given only as needed:
Does the camper have seizures?
Are there any known circumstances that may cause a seizure such as heat or fatigue?
When was the camper’s last seizure?
If camper experiences a seizure:
Do you want emergency medical services to be called?
Do you want to be called?
Instructions if a camper has a seizure:
Camp Atlantic, www.campatlantic.org, provides a beach vacation to
adults with intellectual disabilities.
is able to participate in the camp's activities with the following restrictions:
If you have any questions about the camp's activities, contact
Tom Ingoldsby at firstname.lastname@example.org or at 703 863-9485.
Please send with the participation at the start of camp written confirmation of the participant's vaccination against COVID-19.
Relationship to Camper:
Please make sure that you have included enough medication for the length of the camp!