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Summer at Madeira Required Forms

All campers must submit the appropriate health and medication forms prior to their arrival at camp. All forms are due to the health office by June 1, 2020. Campers will not be allowed to remain at camp if they arrive on the first day of their program without up-to-date, completed, and signed forms. All camper forms and forms from doctor's offices must be submitted in English. At this time we are unable to accept forms in any other languages.

Due Date: June 1, 2020

Forms

Download the Health Form

Download the Emergency Care Plan for EpiPens

Download the Asthma Action Plan for Inhalers

Download the Medication Consent Form for all Medications

Uploading Your Forms

All health documents should be uploaded by the parent or guardian through the online Registration Portal. Submitting these forms directly to your campers' registration page is the fastest way to get them to our health team.

Health Forms

Requirements

All campers must have a completed Virginia School Entrance Health Form, or the equivalent form for their state of residence, on file prior to the start of camp. The camp health form includes three parts:

1. The Health Information Form, signed by the parent or guardian 

2. An Immunization Record, signed by the doctor

3. A current Physical Examination Record, signed by the doctor

Returning Campers

  • If your child carries an Epi Pen, Inhaler, or will bring medications to camp, the appropriate forms (Allergy Action PlanAsthma Action PlanMedication Administration Authorization Form) must be re-submitted annually.
  • All rising 8th graders must submit a new immunization record.
  • Only physical examinations completed in 2018, 2019, and 2020 are accepted for the Summer of 2020. If your camper attended any of our programs last summer, or the summer before, it is possible that their physical and immunization forms could carry over, however, please ensure you are checking against the date of the physical, not when the doctor signed off on the form. We encourage all parents of returning campers to contact the camp nurses to directly to check that your physical and immunization forms are compliant with our policies. 

EpiPens, Inhalers, and other Medications

Requirements

If your child has been prescribed medication that he/she will need to bring onto the Madeira campus, you must:

1. Complete an Emergency Care Plan for all EpiPens

2. Complete an Asthma Action Plan for all Inhalers

3. Complete a Medication Consent Form for all other medications

All prescription medications must come to camp in the original pharmacy container, with the prescribing label attached. Please make sure your medication has not expired, as it will not be accepted.

  • The Madeira Health and Wellness Center is stocked with over-the-counter medications; therefore, campers should NOT bring medications such as Acetaminophen (e.g. Tylenol), Ibuprofen (e.g. Advil), Diphenhydramine (e.g. Benadryl), Antibiotic Ointment (e.g. Neosporin), and TUMS to camp. The Health Center will contact the parents/guardian directly to obtain permission to dispense over-the-counter medications to the camper if necessary.
  • No camper may carry, keep, or dispense for herself/himself or any other camper any prescription or over-the-counter medications.
  • Non-compliance with this policy may result in dismissal from camp without a refund. 

New Campers

  • Campers who have not attended a Summer at Madeira program, or campers who are a returning camper from 2017 or before, must upload a completed form packet through the online Registration Portal. Immunization Records must be up-to-date and Physical Examination Records must have been completed after June 1, 2019.

Returning Campers

  • If your child carries an Epi Pen, Inhaler, or will bring medications to camp, the appropriate forms (Allergy Action Plan; Asthma Action Plan; Medication Administration Authorization Form) must be re-submitted annually.
  • All rising 8th graders must submit a new immunization record.
  • Only physical examinations completed in 2018, 2019, and 2020 are accepted for the Summer of 2020. If your camper attended any of our programs last summer, or the summer before, it is possible that their physical and immunization forms may carry over; please ensure you are checking against the date of the physical, not when the doctor signed off on the form. If you have any questions about your child's physical and immunization forms, we encourage all parents of returning campers to contact the camp nurses directly to check that these forms are compliant with our policies. 

You may contact the camp nurses at any time if you have questions about camper health forms - 703-556-8243

 

Health Forms that are not fully completed will not be accepted. Summer at Madeira reserves the right to withdraw registration for campers whose forms have not been received by June 1, 2020. Refunds are not issued for any camp missed due to inaccurate, out of date, or incomplete health forms.