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City North Cowichan / / Facility FORM MUST BE RETURNED UPON ARRIVAL AT CAMP / Name Of Parent/Guardian_____________________ OFFICE USE ONLY Camp / DO NOT MAIL TO CAMP / Camp Qwanoes / / IndustryTerm transportation / equivalent health insurance / food / / MedicalCondition chronic illnesses / communicable disease / allergies / hypertension / convulsions / communicable diseases / flu / epilepsy / emergency asthma / frequent ear infections / last Tetanus / chicken pox / Any allergies / serious injuries / heart disease / diabetes / disorders / Is Tetanus / asthma / / MedicalTreatment immunization / first aid / / NaturalFeature Maple Mountain / / Organization Registered Nurses’ Association of B.C. / B.C. Camping Association / / / Position Physician / Registrar / REPRESENTATIVE / camp director / Dentist / / Product Regarding Medication / MEDICATION NAME REASON FOR MEDICATION / / ProvinceOrState North Cowichan / British Columbia / / SocialTag 
medicalform TO BE COMPLETED BY PARENT/GUARDIAN JUST PRIOR TO CAMP AND HANDED IN TO CAMP REPRESENTATIVE UPON ARRIVAL AT CAMP OR AT THE TSAWWASSEN FERRY TERMINAL USE ADDITIONAL PAPER IF REQUIRED UÊPLEASE PRINT