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Medical Information: If your camper takes any medications or vitamins complete the medication form Is the camper’s immunizations up to date?
Is the camper allergic to anything? If so, what _____________________________________________________________________________________ Please include instructions on administration of any allergy medication ______________________________________________________________________________________________ ______________________________________________________________________________________________ Behavioural Information, please be descriptive 1. Please list and describe any diagnosis this child has received (i.e. fasd, conduct disorder, etc.) ____________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. How well does this camper listen to instruction? ____________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ 3. How well does this camper respect authority? ____________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ 4. Does this camper have a history of violence, ie. fighting, bullying, etc.? Note any aggression ______________________________________________________________________________________________________________________________________________________________________ ______________________________________ ______________________________________________________________________________________________________ 5. Does this camper have a history of stealing? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 6. Does this camper have a history of lying? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 7. Does this camper have a history of, or have displayed any unhealthy sexual behaviour? Please explain ____________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ 8. Does this camper get along well with other children their age? ____________________________________________________________________________________________________________________________________________________________________________________________________________ 9. Does this child have a history of any alcohol or drug use? Do they smoke? ____________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ 10. How does this child feel about coming to Camp Connections? ____________________________________________________________________________________________________________________________________________________________________________________________________________
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