Student Supplemental Form Student Supplemental Form This form is designed to address a variety of medical conditions/disorders. Please read carefully and complete truthfully. SEACAMP Summer Camp Programs provide 24-hour 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 $50.00 processing fee. Student Name * SEACAMP Program(s) * SEACAMP I SEACAMP II SEACAMP III SEACAMP I Session Dates * June 10 - 15, 2023 July 1 - 6, 2023 July 15 - 20, 2023 SEACAMP II Session Dates * June 16 - 22, 2023 July 7 - 13, 2023 July 21 - 27, 2023 SEACAMP II Session Date June 23 - 30, 2023 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. 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. Storage: Medications should be packed in a zip-top bag labeled with your student's name. Medications will be collected each night before bedtime and stored in a locked case overnight with the exception of emergency medications which are required to stay with the student at all times. Medications will be returned to the student in the morning. I understand that prescription medications are held and administered by student and daily general group reminders to take their medications will be sufficient. * 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 an away-from-home experience and has successful "off-line" coping mechanisms to manage medical condition/disorder (such as a comfort stuffed animal, pictures of/notes from family to look at or a journal to write in). 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 program and all 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 02/04/2023 If you are human, leave this field blank. Submit
