Student Supplemental Form School Year

This form is designed to address a variety of medical conditions/disorders. Please read carefully and complete truthfully. SEACAMP 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, either school chaperone or a parent will need to accompany the student.

Student First Name *

Student Last Name

Name of School/Group

Specify medical condition/disorder *

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

Yes

No

Specify prescription medication(s)

Information: Students will hold and administer all prescription medications unless school chaperones are administering. Instructors will provide generally medication reminders to the group 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 or administered by the chaperones for the student’s school and simple 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. *

As the parent/guardian of above student *

I verify the above information provided is true and accurate and that my child is able to safety and successfully attend/participate at SEACAMP San Diego.

Parent/Guardian Name *

Upload Your Profile

Student Supplemental Form - School Year