Medical Information & Media Release

Below is the medical information and media release required for participation in Calypso's Summer Camps, Farm School and Youth Leadership Program.

Please contact us if you have any questions or concerns!


Child's Information

Name of Child*
My child is participating in:*

Allergies & Medications

Does your child have any known allergies?*
Will your child be carrying and self-administering any medication?*
If yes, you are acknowledging that it is your child's responsibility to know proper dosage and time of administration.
Self-Administration of Medication for Asthma and Anaphylaxis (Inhalers or Autoinjectable Epinephrine)
Over the Counter Medications*
Calypso First Aid kits are equipped with over-the-counter Diphenhydramine (Benadryl) that can be administered in the case of allergic reactions (when other interventions are not indicated). Do Calypso Farm staff members have your permission to administer the following over-the-counter medications as needed: Diphenhydramine (ex: Benadryl)

Health History

Does your child have any activity restrictions?*
Does your child have a history of or are they currently experiencing any of the following?*
We do a lot of cooking from the garden during Farm programs. In addition to any allergies listed above, does your child have any dietary restrictions we should be aware of? If so, describe below.
COVID-19 Vaccination*
Is your camper up to date on recommended COVID-19 vaccinations? This is not required to attend camp but will affect our quarantine requirements in case of possible exposure.
Is there anything additional we should be aware of when it comes to your child’s health in the context of COVID-19? If so, please describe below.

Physician Information

Emergency Contacts

Address*
Transportation Consent*

Media Release & Signature

Media Release for a Minor
Electronic Signature*
Date*