R 400.11127(1) and (2) Camper Health History Form

Camper Health History Form

Legal Reference: R 400.11127(1) and (2) Camper Health History Statement

1. A camp shall maintain, in the camp, for each camper and minor staff person, a statement signed by an authorized person that authorizes the camp to consent to emergency medical or surgical treatment of the camper and minor staff person and to routine, nonsurgical medical care. If there is a religious objection to consenting to receipt of emergency medical or surgical treatment, the authorized person shall submit a written statement to the effect that the camper is in good health and that the person signing assumes the health responsibility for the camper.
2. A camp shall maintain, in the camp, a health history statement signed by an authorized person for each camper and minor staff person. The statement shall include all of the following information:
   1. Current prescription and nonprescription drugs and medications.
   2. Immunization status.
   3. Physical limitations.
   4. Allergies.
   5. Any special health and behavioral considerations.

Download Camper Health History Record Sample