Counsellor in Training Registration

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Relationship to CIT

Specify type:

Name of Disorder:

Specify Type:

Name of Condition:

Specify type (Absence [Petit Mal] or Tonic-Clonic [Grand Mal]), causes, symptoms, and date of most recent seizure

Are there any other health and wellness needs we should be aware of?

CIT's Medicare Number:

CIT's Current Medication:

If medication needs to be taken during camp hours please list the medication and any special instructions for assistance the CIT may require with taking the medication. Depending on the class of medication, a safe space to house it away from campers may be required.

Allergies: Please describe any allergies your child may have. Please note that CITs are expected to bring their own lunch, snacks, and water. *No nuts will be permitted at the camp*

Please describe the allergy, reaction, treatment and indicate if it is life threatening. *If Epi-Pen treatment has been indicated above, please ensure that your child brings it with them to camp and that staff are aware of its location.

If yes to Asthma, please indicate specific triggers:

Is there anything else you would like the Camp Director to know in order to ensure a safe and successful experience at camp?

CIT Registration Form

CIT Registration Information

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