ALLERGIES  List all known. Describe reaction and management of the reaction. Medication allergies (list) Food allergies (list) Other allergies (list) — include insect stings, hay fever, asthma, animal dander, etc. MEDICATIONS BEING TAKEN Please  list  ALL  medications  (including  over-the-counter  or nonprescription  drugs)  taken  routinely.  Bring  enough medication to last the entire time at camp. Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. o This person takes medications as follows: Med #1 ___________________________  Dosage  ________   Specific times taken each day  __________________ Reason for taking_______________________________________________________________________________ Med #2 ___________________________  Dosage  ________   Specific times taken each day  __________________ Reason for taking_______________________________________________________________________________ Med #3 ___________________________  Dosage  ________   Specific times taken each day  __________________ Reason for taking_______________________________________________________________________________ Attach additional pages for more medications. Identify any medications taken during the school year that participant does/may not take during the summer:  _______ Dietary o Does not eat red meat o Does not eat pork o Does not eat eggs o Does not eat poultry o Does not eat seafood o Does not eat dairy products o Other (describe) _____________________________________________________________________________________ Explain any restrictions to activity (e.g. what cannot be done, what adaptations or limitations are necessary) RESTRICTIONS The following restrictions apply to this individual. Health History The  following  information  must  be  filled  in  by  the  parent/ guardian, or adult camper or staff member. The intent of this information  is  to  provide  camp  health  care  personnel  the background to provide appropriate care. Keep a copy of the completed  form  for  your  records.  Any  changes  to  this  form should  be  provided  to  camp  health  personnel  upon participant’s arrival in camp. Provide complete information so that the camp can be aware of your needs. o This person takes NO medications on a routine basis.