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 11 - 16, 2022 July 2 - 7, 2022 July 16 - 21, 2022 SEACAMP II Session Dates * June 17 - 23, 2022 July 8 - 14, 2022 July 22 - 28, 2020 SEACAMP II Session Date June 24 - July 1, 2022 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 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. * Yes No My child will not find a classroom environment difficult. I understand all SEACAMP labs have a hands-on component(s) but students are expected to be respectful of SEACAMP staff and other students. Labs can last as long as two hours. * 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. * Yes No My child is prepared for an away-from-home experience and has a way to deal with homesickness in the event it occurs (other than calling home - 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. * Yes No My child has constructive methods to deal with feelings of frustration, anxiety, anger or other negative feelings. Should any arise during the session, 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 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 activities. * Yes No If your child should come to us stating they are agitated, overwhelmed or upset, is there a familiar comfort we can provide? Or any additional information that may assist in a successful camp experience for your child? * 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 05/18/2022 If you are human, leave this field blank. Submit
