Provide the month and year for each immunization. Starred (*) immunizations must be current. Copies of immunization forms from healthcare providers, or state or local government, are acceptable; please send into WeHaKee Camp for Girls.
Please provide all immunization dates.
Because our camp program has a potential for communicable diseases, we expect that program participants are appropriately immunized for, at minimum, the following diseases: tetanus, mumps, measles, rubella, polio, pertussis (whooping cough), meningitis, hepatitis B, varicella (chicken pox) and diphtheria. If this participant is not fully immunized per our expectation, please contact our Administrative Office prior to completing this Health History form.
ALL PRESCRIPTION MEDICATIONS MUST BE IN ORIGINAL PHARMACY CONTAINER WITH LABELS which shows the camper’s name and how the medication should be given. Provide enough of each medication to last the entire time the camper will be at camp.
Please do not send non-prescription medications with your child unless they are needed on a daily basis. If you send non-prescription medication with your child, IT MUST BE IN ITS ORIGINAL CONTAINER WITH LABELS. The below non-prescription medications may be stocked in the Health Center (BandAid) and are used on an as needed basis (PRN) to manage illness and injury. PLEASE SELECT THOSE THE CAMPER SHOULD NOT BE GIVEN.
The information provided will not be shared with third parties.