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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).

Medication Policies

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.

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.

Step 1: Printing the Form

- Please print the 2 page Summer Camp Medication Form.
- Please note that the form only needs to be completed once per summer, unless there are changes.
- Each medication requires a separate form.

Step 2: Completing the Form

- Please read the form carefully and completely.
- 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. You can add a photo of your child on a separate page and then upload it all as one document in the next step or email a photo of your child to sgebe@deerfieldtwp.com.

Step 3: Submitting the Form Electronically

Forms must be submitted at least 10 business days prior to the first day of camp.

1. Please log into your DeerfieldRec.com account.
2. If you are not brought to your Account Overview screen, please follow the top menu Account > My Account.
3. On the Account Overview screen, click on the name of the child for which you would like to upload a form.
4. Scroll down to the bottom of the page to the Required Documents section.
5. Upload the signed and completed document using the appropriate Summer Camp Medication Form link.
6. Documents will be reviewed by the Camp Director prior to approval.

*If you are unable to submit the form electronically, please bring a paper copy to the Township Office at 4900 Parkway Drive, Suite 150, 45040.