CELP Allergy/Food Intolerance Form
PLEASE ONLY FILL OUT THIS FORM IF YOU OR YOUR CHILD HAS AN ALLERGY OR FOOD INTOLERANCE AND WILL REQUIRE SPECIAL ACCOMMODATIONS AT CAMP. ALL PARTICIPANTS ARE REQUIRED TO FILL OUT SEPARATE CELP HEALTH FORM PROVIDED BY YOUR SCHOOL.
Email address *
School Information
Name of School *
Your answer
Trip Dates *
Your answer
CELP Participant Information
A CELP participant is any student, teacher or parent attending CELP.
Name of CELP Participant with allergy or food intolerance: *
Your answer
This person is a: *
Required
Medical Information
Please provide DETAILED information below to ensure a healthy camp experience.
Please list participant's allergies or food intolerances: *
Your answer
What is the reaction to the allergen or food?
Your answer
If exposed to the allergen or food, what treatment should be provided?
Your answer
What medication(s) will be brought on the trip?
Your answer
Are there any special instructions on use or storage or medications?
Your answer
Will special meal arrangements be required?
If yes, please describe in detail.
Your answer
Name and Contact Info of Person Completing this Form
This form completed by:
Please provide name below:
Your answer
Relation to participant:
Example: parent, guardian, health professional, etc.
Your answer
If we have further questions, how can we contact you?
Please provide phone and/or email address below:
Your answer
Notes/questions:
Your answer
Thank you for providing the information above. You will be contacted by CELP if there are any questions or if further coordination is required. If you would like to contact us directly, please email CELP wellness coordinator Holly Kern at wellness@catalinaislandcamps.com
A copy of your responses will be emailed to the address you provided.
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