OVER THE COUNTER MEDICATION PERMISSION SLIP Camp Attending: (please circle) Boy Scout Summer Camps Camp Bonaparte Camp Fife Cub Scout Day Camps Ephrata Grandview Wenatchee Kittitas Moses Lake Omak Othello Selah/Yakima Scout Name: _____________________ Unit No: ____________________ Dates of Camp Session Attending: ___________________________ Scout Date of Birth: ___________________________ I give the camp staff leadership permission to administer the following over-the-counter medications, should the need arise, while the Scout is at camp. I further certify that, to the best of my knowledge, the Scout is not allergic to any of the approved over-the-counter medications. Dosages will be administered according to the directions on the label unless a physician directs otherwise. Please cross off any medications that are NOT approved and sign below: Pills and Chewables Headache Tylenol (acetaminophen) or Motrin (ibuprofen) Muscle Pain Motrin (ibuprofen) Upset Stomach Pepto Bismol (bismuth subsalicylate), Tums (calcium carbonate), Maalox ( magnesium hydroxide and aluminum hydroxide) Diarrhea Immodium AD (Loperamide HCI) Bee/Wasp sting Benadryl (Diphenhudramine HCI) Allergy Benadryl (Diphenhudramine HCI) Cold Medicine Sudafed (Pseudoephedrine HCI) Topical Cuts Bacitracin-neomycin-polymyxin-B antibiotic ointment Poison Ivy Calamine lotion (zinc oxide), Benadryl cream (diphendydramine) or Cortaid cream (hydrocortisone) Bites and itches Calamine lotion (zinc oxide), Benadryl cream (diphendydramine) or Cortaid cream (hydrocortisone) Athletes Foot Tinactin spray (Tolnafrate) Sunburn Solarcaine spray (Lidocain, Triclosan), Aloe These items are stored in the camp health lodge. Please do not send these medications with the Scout. Generic brands may be substituted for name brands. Print Scout’s name: __________________________________________________________________ Parent/Guardian signature: _________________________________ Date: ___________________ Parent/Guardian phone number: ________________________________________________________

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CAMP SPECIAL REQUESTS FORM

Please return this form to: 12 North 10th Ave, Yakima WA 98902-3015; or fax to 509-457-3222; or email to beckie.hess@scouting.org. This form is to be used to notify the Grand Columbia Council of any special dietary, health, mobility or dis-ability needs your unit will have at camp or at the activity attending. The Grand Columbia Council will make every reasonable effort to accommodate your special needs. It is the responsibility of parents and/or adults attending to make sure the person has everything the person needs for the time of the activity. This form will be submitted to the camp or activity personnel. Please be specific in explaining the needs and attach additional sheets if necessary. The contact person you list below may be contacted if event staff have any questions. Please use a separate sheet for each individual requiring accommoda-tions. Please submit this form by May 31 for summer camp but no later than three weeks prior for other activities. _______________________________ _____________ ______________ _______________________ Person Needing Accommodations Youth or Adult Reservation # Date arriving at camp/activity

Pack Troop Team Crew Ship _________ ____________ _____________ ___________________ Circle type of Unit Unit # District Council Name of camp/activity

attending

_____________________ _________________ _________________ ___________________________ Contact Person Contact Person Contact Person Contact Person Email Daytime Phone # Evening Phone #

Please check those that apply. ____CPAP Machine ____Mobility ____Dietary* ____Allergies* ____Asthma ____Other List any additional information: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

FORM MUST BE SUBMITTED BY MAY 31 FOR SUMMER CAMP

NO LATER THAN 3 WEEKS BEFORE OTHER ACTIVITIES

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