Living Waters Wilderness Adventures - Sign Up - Health Record Form

Text Box: Permission to Self Administer Emergency Medications Form Campers name ________________________ Trip attending________________________ Dates______________ If it is necessary for this camper to self-administer any emergency medications. Written approval must be given by their primary health care provider and the camper’s parent or legal guardian. This is verification that this camper has the knowledge and skills to safely self-administer emergency medications and has authorization to do so while at Living Waters Signed (Primary Health Care Provider) ______________________Date:___________ Signed (Parent or guardian) ______________________Date____________ During registration, the camper will need to demonstrate to the trip leader that they know how to properly self-administer emergency medications. The trip leader will discuss with the camper the proper safe keeping and care of these medications while camper is in our care. Back Forward