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WI Camper Health History Record 2015 free printable template

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DEPARTMENT OF HEALTH SERVICES Division of Public Health F01444 (01/2015) STATE OF WISCONSIN Admin. Code ch. Adm. 175-Page 1 of 2 CAMPER HEALTH HISTORY RECORD INSTRUCTIONS TO PARENT: COMPLETE AND RETURN
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WI Camper Health History Record Form Versions

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How to fill out WI Camper Health History Record

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How to fill out WI Camper Health History Record

01
Obtain the WI Camper Health History Record form from the camp or relevant authority.
02
Fill in the camper's personal information: name, date of birth, address, and emergency contact details.
03
Provide details about the camper's medical history, including previous illnesses, surgeries, and hospitalizations.
04
List any allergies the camper has, including food, medication, and environmental allergies.
05
Fill out current medications being taken, dosages, and the prescribing physician's information.
06
Include information on any chronic conditions or disabilities that may affect the camper's participation.
07
Sign and date the form, confirming the information is accurate and complete.
08
Submit the completed form by the camp's deadline.

Who needs WI Camper Health History Record?

01
All campers attending summer camps in Wisconsin are required to fill out the WI Camper Health History Record.
02
Parents or guardians of the campers need to complete this form to ensure proper health care and accommodations.
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The WI Camper Health History Record is a document required to collect information about a camper's health history, ensuring that the camp staff is informed of any medical conditions, allergies, or special needs the camper may have.
Parents or guardians of campers are required to file the WI Camper Health History Record for each child attending camp.
To fill out the WI Camper Health History Record, parents or guardians should provide detailed information about the camper's medical history, including any allergies, medications, previous illnesses, and any necessary emergency contact information.
The purpose of the WI Camper Health History Record is to ensure that camp staff are informed about each camper's health needs and can provide appropriate care in case of an emergency or medical issue.
The information that must be reported on the WI Camper Health History Record includes the camper's medical history, allergies, current medications, immunization records, emergency contact details, and any other relevant health information.
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