Summer Camp Medication Form
This form is used for minors attending a Deerfield Township Summer Camp (camps staffed and managed by the Deerfield Township Parks and Recreation Department).
Only medications that are prescribed by a physician or necessary to treat a disability are allowed at camp. In order to bring an Epi-pen, inhaler, or other medication to camp, a parent/guardian must submit a completed Summer Camp Medication Form at least 10 business days prior to the first day of camp. Each medication requires a separate form.
Step 1: Printing the Form
Approved medications must:
- Be in the original prescription container
- Be clearly marked with the child’s name
- Have a current date (not expired)
- Be brought to camp staff upon arrival on the first day of camp
- Be signed in/out by an authorized adult each day (if the child is not authorized as self-carry)
Camp staff are not medical professionals and are not authorized to administer medication. (Camp staff are First Aid/CPR Certified.)
- Children are required to self-administer medications, whenever possible.
- Camp staff are trained in administering epi-pens and may assist with administration in an emergency.
- If a child is not authorized as self-carry, camp staff may hold the medication until the child asks for it.
- Camp staff are not authorized to remind children of medication times.
- Please print the 2 page Summer Camp Medication Form.
Step 2: Completing the Form
- Please note that the form only needs to be completed once per summer, unless there are changes.
- Each medication requires a separate form.
- Please read the form carefully and completely.
Step 3: Submitting the Form
- Part 2 must be completed and signed by the child's Health Care Provider.
- Part 3 & 4 must be completed and signed by the child's legal parent/guardian.
- A current photo is helpful for verifying the identification of a child. The photo doesn't need to be anything fancy, just one where we can see the child's face. It may be printed on standard copy paper. You can email photos to the Camp Director, Maria Iannelli, at firstname.lastname@example.org or include it with the mail/in-person forms.
Forms must be submitted at least 10 business days prior to the first day of camp.
Forms may be emailed directly to the Camp Director, Maria Iannelli, at email@example.com.
Paper copies may be mailed or brought to the Township Administration Office at the following address:
Attn: Maria Iannelli
4900 Parkway Drive
Mason, OH 45040