Student Supplemental Form – School Year Day Camp

This form is designed to address a variety of medical conditions/disorders. Please read carefully and complete truthfully.

Student Name *

Name of Schoo/Group

Specify medical condition/disorder *

Does student take prescription medication(s) for this medical condition/disorder? *

Yes

No

Specify prescription medication(s)

Will student be bringing medication to camp each day?

Yes

No

Information: If prescription medications are brought to camp, the student or a school chaperone must hold and administer those medications. SEACAMP San Diego instructors are not permitted to do so. Please coordinate with your School Representative regarding medications.

I understand prescription medications that are brought to camp will be held and administered by the student or school chaperone. *

Yes

My child will be prepared for a camp setting with a busy schedule with little “down time.” Unsupervised “alone time” is not an option. Students are expected to be respectful of SEACAMP staff and other students at all times. *

Yes

No

My child is prepared for a camp experience and has successful "off-line" coping mechanisms to manage medical condition/disorder. Part of attending camp is stretching boundaries and learning new skills. However, should feelings of frustration, anxiety, anger or other negative feelings arise during camp, my child knows to approach an adult to ask for help. My child and I understand that aggressive or violent responses will not be tolerated. *

Yes

No

My child will be able to follow staff instructions and will be able to respond to directions quickly, especially during field activities. A quick response to lifeguard instructions may be necessary for students’ safety. My child and I have reviewed the planned schedule and have discussed the importance of being flexible, if needed. *

Yes

No

My child‘s medical condition(s) is well managed and child will be able to safely participate in all program and activities. *

Yes

No

Provide additional information regarding your student’s medical condition/disorder including suggestions should your student become agitated or upset. *

Parent/Guardian Signature

Electronic Signature Consent

I Accept - by selecting “I Accept,” you are signing this Agreement electronically. You acknowledge you have read and understand the above terms, and you agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. Click here for the full Electronic Signature Consent agreement.

As the parent/guardian of above student who is now a minor: *

I verify the above information provided is true and accurate, and affirm that I am at least 18 years old with my signature below.

Parent/Guardian Name *

Parent/Guardian E-Signature *

Clear

Date of E-Signature

12/15/2025

Text

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Student Supplemental Form - School Year Day Camp

Parent/Guardian Signature