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2015 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM Please return completed forms NO LATER than two weeks prior the start of camp. Only one set of forms per camper should be submitted per calendar year General Informat
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Document Date: 2014-12-14 21:49:15

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File Size: 234,98 KB

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Facility

Institute of Natural Science P.O. Box / Camp Program / Vermont Institute of Natural Science Nature Camps / camp hours /

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IndustryTerm

social media / registration communications / medical equipment / /

MedicalCondition

allergies / ___Ear Infections ___Frequent Colds ___Hypertension ___Mononucleosis ___Hayfever ___Penicillin Allergy / Medical Information Allergies / chicken pox / physical injury / Poison Ivy ___Diabetes ___Insect Stings ___Bleeding Disorder ___Food/Other Allergies ___Asthma ___Cramps ___Psychiatric Treatment ___ADD/ADHD ___Heart Disease ___Epilepsy/Seizures / last Tetanus / illness / minor injuries / varicella / injuries / asthma / /

MedicalTreatment

immunizations / /

Organization

Camp Registrar Vermont Institute / Vermont Institute of Natural Science / Vermont Institute of Natural Science Nature Camps / /

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Position

Camp Program Coordinator / licensed hospital physician / name Office Phone Number Dentist / Physician / General Information Child / VINS Camp Program Coordinator / Insurance Company Policy/Group Number Participant ID Number Physician / licensed physician / /

Product

VINS Nature Camp Camper Medication / Penicillin / Dispense Medication / EpiPen / MEDICATION DOSAGE SPECIFIC TIME TAKEN DOSAGE SPECIFIC TIME TAKEN REASON FOR TAKING MEDICATION / /

ProvinceOrState

Vermont / /

URL

www.vinsweb.org / /

SocialTag