LukeCamp Medical Form

This form includes any and all medical device equipment that your child may need. Such would include asthma pumps, EpiPens, etc. Include any allergies or medical condition that your child may have, along with the required device for each.

Camper Name

Any known allergies or food allergies:

Has your child ever been stung by a bee?

YES

Any additional medical information that we need to be aware of:

I am sending the following medicine or medical equipment with my child:

Condition Device to Administer

Date

Parent/Guardian’s Signature *

Draw It
Type It
Clear

I certify that the attached photo is proof of my own medical device showing my name as the prescribed applicant, along with the expiration date. I intend to have this with me at all times during camp.

Attach Photo

Maximum file size: 16.78MB