NOTE: Terrapin Adventures does not accept paper waivers, please submit electronically.

Camper Health Form

Camper's First and Last Name

First and Last Name of the Camper's Primary Care Physician or Medical Care Provider?

What is the Physician/Provider's Phone Number?

Does the Camper have Medication they will need at Camp?

Don't forget to include medications they will need during their overnight, if applicable. Medications include prescription drugs, over the counter drugs, vitamins, ointments, and holistic treatments.

Please list any allergies the Camper has.

If none, write "none"

What allergy is the Epi-Pen for?

What happens when the Camper is exposed to the allergen?

I understand that in order for my child to bring a medication, inhaler, or epi-pen, that I must submit a medication administration form, signed by a physician prior to camp. The form may not be the same form the child uses at their school.

Medication without forms cannot be in camper possession or administered while at camp. No exceptions. Terrapin Adventures staff cannot administer medication to campers.

Does the Camper have any Mental Health, Psychological, or Behavioral conditions?

If yes, please describe in detail.

Is the Camper likely to experience Daytime wetting or Bedwetting at Camp?

Please Check off any of the below conditions that apply to the Camper, regardless of severity.

Mental or Developmental Disorder

Hearing Condition

Vision Condition

ADHD/ADD

Autism/Aspergers

Sensory Sensitivity or Sensory Processing Disorder

Summer Seasonal Allergies

Frequent Upset Stomach

Gastrointestinal or Digestive Issues

Chrons, Irritable Bowel Syndrome, Chronic Constipation, etc

Diabetes

Injury or Past Injury that affects Physical Activity

Skin Condition

Heart Condition

Bleeding or Clotting Disorder

Fainting or Dizziness

Other

Please describe thoroughly all of the boxes checked above. If the camper has any other special needs or circumstances, please list them and describe thoroughly.

For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?

If yes, list all vaccinations the child is exempt from.

Campers that reside outside the United States, a United States Territory, or the District of Columbia: You must submit a record of immunization or immunity to the Camp Director via email at Campdirector@terrapinadventures.com

Click to Sign

I confirm that the information given in this form is true, complete and accurate at the time of submission. I will submit a new form if any health information changes.

NOTE: Terrapin Adventures does not accept paper waivers, please submit electronically.

Camper Health Form

2021 Camper Health Form