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2. Medication Form for Day Camp Participant

   • Medication must accompany the camper in original contained and turned into staff at drop off. 
   • For medication to be administered, camper must see the Camp Director or designee. 
   • Medication is NOT to be kept in lunchboxes, backpacks, or with camper. 
   • A new form must be filled out for each additional medication. 
4. Camper's Name*
5. Parent/Guardian Name*
7. I hereby grant permission to the Camp Director or designee to assist in the administration of the following medication to my child:
9. Name of Medication*
10. Dosage*
12. Treatment Of*
13. Administration Time*
15. Physician Name*
16. Number*
18. Waiver to Administer Medication*

    The listed Parent/Guardian recognizes that the Branson Parks and Recreation Day Camp staff member, who will be responsible for ensuring above medication, is not a pharmacist and accepts full responsibility for ensuring the above medication and further acknowledges that neither such a person or the City of Branson shall have any responsibility or liability arising from the above listed child taking medication in accordance with the instructions on the label. The listed Parent/Guardian also authorizes a Branson Parks and Recreation Day Camp staff member to administer the medication listed above. By checking "Accept" you acknowledge you are the listed Parent/Guardian and you agree to the terms listed above.

    1. Accept
20. My child has asthma and is able to carry and administer their own inhaler

    Staff must remain notified of inhaler, but camper has permission to administer as needed

    1. Yes
    2. No
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field