MEDICAL INFORMATION FOR CENTER RIDGE OUTPOST 2026

Please fill this out for your camper. If camper has no medication please just say none.

Date Date / MM / DD YYYY
Camper's Name Camper's Name First Middle Last
Camper's Birthday Camper's Birthday / MM / DD YYYY
Parent/Guardian email
Parent/Guardian's Cell Phone Number Parent/Guardian's Cell Phone Number - ### - ### ####
At our Outpost programs, we will be able to provide first aid through our nursing and/or first responder volunteers. If your camper requires any prescription or over-the-counter (OTC) medications or special medical treatment please list:

MEDICATIONS: Please list ALL medications**, purpose of drug, dosages, times medication is taken:
Can Camper take Aspirin?

Can Camper take Aspirin? Yes No
Can Camper take Tylenol?

Can Camper take Tylenol? Yes No
Hospital by Choice:
LIST ANY OTHER MEDICATIONS ON A SEPARATE SHEET.

**Please Note: Campers are expected to bring sufficient supplies of their medication, properly identified, with complete directions for their use. The Center Ridge Outpost will not provide prescription medicine. Please send enough for the camper's entire stay. Any excess medication will be returned. Medication should be in a mediate or in current prescription bottles.

Please list any known allergies (medicine, food, other)
By signing below I verify the above information to be current and accurate. I give permission to The Center Ridge Outpost staff/volunteers to give/assist with my childs medications/medical concerns.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY