Student Supplemental Form – Day Camp

This form is designed to address a variety of medical conditions/disorders. Please read carefully and complete truthfully. SEACAMP Summer Camp Programs provides all supervision. However, SEACAMP is not equipped to provide one-on-one individualized care. Students will need to be able to participate fully with the group in all activities. If it is determined that your student will need more care than our staff can provide, we would consider this a medical exception to our refund policies and all camp tuition would be returned in minus a $150.00 processing fee.

Student Name *

Select Program

Spring Break Camp

SEACAMP Jr.

Program Date

April 1 - 5, 2024

SEACAMP Jr. Session Date *

Specify medical condition/disorder *

Does student take prescription medication(s) for this medical condition/disorder? *

Yes

No

Specify prescription medication(s)

Prescription medication(s) should also be designated on Student Health Form in the Registration Forms. Answer Yes to the question "Does student take prescription medications?" and list medication(s).

Information: Students will hold and administer all prescription medications. Instructors will provide daily medication reminders in the morning at breakfast and in the evening at dinner.

I understand, if prescription medications are brought to camp, they will be held and administered by the student. *

Yes

My child will be prepared for a camp setting - camp is highly social and will include but is not limited to the close proximity of other students (in labs, dorms, etc.) and a busy schedule with little “down time.” Unsupervised “alone time” is not an option. Students are expected to be respectful of SEACAMP staff and other students at all times. *

Yes

No

My child is prepared for a camp experience and has successful "off-line" coping mechanisms to manage medical condition/disorder. Part of attending camp is stretching boundaries and learning new skills. However, should feelings of frustration, anxiety, anger or other negative feelings arise during camp, my child knows to approach an adult to ask for help. My child and I understand that aggressive or violent responses will not be tolerated. *

Yes

No

My child will be able to follow staff instructions and will be able to respond to directions quickly, especially during field activities. A quick response to lifeguard instructions may be necessary for students’ safety. My child and I have reviewed the planned schedule and have discussed the importance of being flexible, if needed. *

Yes

No

My child‘s medical condition(s) is well managed and child will be able to safely participate in all program and activities. *

Yes

No

Provide additional information regarding your student’s medical condition/disorder including suggestions should your student become agitated or upset. *

Parent/Guardian Signature

Electronic Signature Consent

I Accept - by selecting “I Accept,” you are signing this Agreement electronically. You acknowledge you have read and understand the above terms, and you agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. Click here for the full Electronic Signature Consent agreement.

As the parent/guardian of above student who is now a minor: *

I verify the above information provided is true and accurate, and affirm that I am at least 18 years old with my signature below.

Parent/Guardian Name *

Parent/Guardian E-Signature *

Clear

Date of E-Signature

04/17/2024

Text

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Student Supplemental Form - Day Camp

Parent/Guardian Signature