Mar 25 2021
Please Note: Campers/Families will be required to attend the Camp Keaton Meet & Greet evening event on Tuesday, May 21, 2019.
If your child requires an EpiPen, you must send him/her to camp with one that is within the expiry date.
Immunization: Please give the date of the last immunization shot (mm/dd/yy):
Give details of all allergic reactions, and of major or recent illnesses, operations, injuries and treatments. Give details of any other physical or emotional problems for which treatment of support may be necessary at camp
Please provide details regarding the issue(s) checked off or any other significant medical issues requiring the full awareness of camp program facilitators
Please list all prescription medications and non-prescription medicines you will be bringing to camp
To the best of my knowledge, is in good health, free of communicable disease, and physically able to participate in all the activities, except as noted above. In case of medical and/or surgical emergency, and in the event that I cannot be contacted, I hereby give full authorization to the physician, staff and or nurse selected by the camp director, to secure proper treatment (i.e., hospitalization, injections, transfusions, anesthesia or surgery as appropriately required) for the person as named above. I further authorize Camp Keaton and its agents to disclose any and all information that they deem appropriate and as necessary to secure appropriate care for my child. I agree that I am responsible for any such care rendered to my child and will indemnify and hold harmless Camp Keaton, the Dr. Bob Kemp Hospice and all of their respective affiliated entities, members, agents, service providers, volunteers, employees, medical staff, officers, and directors for such care or related costs or expenses. I certify that the above information is accurate, and that I concur with the statements as described. I understand that by not providing my camp's personal immunization information I may be asked to make the necessary arrangements to pick him/her up from Camp Keaton and Camp Wenonah should a breakout of a communicable disease occur in order to protect myself and other campers.
Please include as many details as possible when answering the following questions. We understand that answering some of these questions might be difficult; however, we want to be able to provide the best possible care for your child/teen.
Please place a check mark next to any of the following your child/teen has exhibited since the death of the loved one:
We would like to remind you that photographs or video clips taken by Camp Keaton are considered Camp Keaton property. Parents and/or caregivers who have given consent for their children/teenager’s photographs to be distributed have done so ONLY for Camp Keaton Management. Campers, volunteers and staff cannot post Camp Keaton pictures on personal web pages, social media (i.e. Facebook, Instagram) or on public photo sharing websites (i.e. Kodak Gallery, Shutterfly or Caring Bridge) without written permission from Camp Keaton.
If photos or videos are found to be displayed on the Internet, in any capacity, without prior permission of Camp Keaton, the person responsible will be contacted immediately to remove the media content. Thank you for your understanding and cooperation in regards to this matter.
Dr Bob Kemp Hospice
277 Stone Church Road East
Hamilton, ON L9B 1B1
Funding for the Dr Bob Kemp Hospice has been provided by the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN).
Charitable Registration #134922392RR0001
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