We would like your child to gain the most from JDI. For us to assist in accomplishing this, it is necessary to have a current health history. Falsifying or failing to disclose information about your health may result in dismissal from the program.
Please list ALL current medications including over-the-counter, non-prescriptions, vitamins and supplements. Bring enough medication to last the entire time at camp. Keep it in the original packaging that identifies the name of the medication, the dosage, and the frequency of administration. ALL medications will be stored in the camp medical center.
Please list all of the participant's allergic reactions.
As the parent/legal guardian to the participant, I hereby declare that the information given in this form is correct and detailed to the best of my knowledge. I agree to notify the camp in writing of any changes prior to the start of the program. I hereby give permission for emergency medical care to take place should it be necessary. hereby give permission for the camper to receive psychological services if necessary. I HEREBY CERTIFY that all statements contained in the Health History Form are true and correct to the best of my knowledge, and further, I AUTHURIZE JDI or any party the JDI authorizes to obtain, or release any information acquired in the course of the participant’s examination or treatment.In case of failure to provide full information or providing false information, I take full responsibility for the consequences of this decision.
In any case, if you believe that the Participant's image has been misused, please contact us at firstname.lastname@example.org, and we will take appropriate actions.