AFFIRM 2019 Medical Form
Complete this form in its entirety. This allows our medical team time to review, and if necessary, follow-up with any questions or concerns. We strongly encourage you to update this form prior to arrival at camp for a smooth check-in.

Please note: AFFIRM medical team stocks things like Advil, tums, sudaphed, etc. Do not send these medications with your camper 'in case'. However, if your camper routinely takes any kind of medication, requires an epi-pen or other prescribed 'in case' meds, plan to send that medication with them and complete this form.

Email address *
Any and all mediation you are sending with your participant must be reported.
AFFIRM policy dictates that all medications - prescription or over-the-counter - including, but not limited to, name brand or generic versions of Advil, Tylenol, Ibuprophin, Tums, Sudafed, etc. - be trurned over at check-in and only be administered by our medical team. The AFFIRM Medical team is comprised of trained medical professionals with decades of experience in first aid care. They are on-call 24-7 during the event.
Loose pills not in the original packaging cannot be accepted. This includes medications in pill boxes or baggies.
Only medications provided in their original packaging will be administered. Additionally, prescriptions must be written for the participant they are being administered to.
Participant's First and Last Name *
Your answer
Participant's Date of Birth *
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