Immunization Record

Please have immunizations recorded on this form or a form that says "Approved by CDPHE." If your doctor submits immunizations on a non approved form, please transcribe onto this form and attach the doctor's copy as well.

• Use the following forms ONLY if your child will need medication DURING camp hours. It is best to arrange to take as many medications at home as possible as we do not have a nurse on staff.
• One form per medication.
• No medications in camp without correct forms signed by both parent and doctor and medication in the original labeled container (Epi pens may be in their plastic tube with a pharmacy label on the outside- this is our preference as it makes them much easier to transport- thank you!).
• Please make clear to your physician that they are filling out the forms for a lay person (camp staff member), NOT a nurse. They must be very clear and black and white with their directions as camp staff are not able to make any medical decisions.
• Please read each explanation to make sure you fill out the correct form.

Severe Allergy Epi Administration is used for severe allergies and Epi Pens
Inhaled Medication Administration is used for any inhaled medications to include albuterol inhalers
Medication Administration is used for all general medications
Exemption for Medication is used if your child has a noted medical condition, but you choose not to send any medications to camp