Complex Medical Conditions, including Diabetes:

If your child has any known medical conditions or diagnosis (besides Asthma, Food Allergies, or a history of Seizures) please alert our office. If your child requires an ACTION PLAN for this known condition or diagnosis, complete the required form below. *Any medications must be stored in our office and labeled with your child’s name in their original prescription labeled container.

ACTION CARE PLAN: COMPLEX MEDICAL
Medication Dispensing Form (Must be signed by your physician)

If your child requires ANY medication while attending Silton Swim School, you are REQUIRED to complete our MEDICATION DISPENSING FORM prior to your child’s first day of camp. We are required to obtain this document in order to dispense ANY medications taken routinely or temporarily. This document requires BOTH A PARENT AND A PHYSICIANS AUTHORIZATION. Medication will not be given without both authorizations.

ALL MEDICATION (PRESCRIPTION OR OVER-THE-COUNTER) MUST BE LABELED WITH YOUR CHILD’S NAME AND STORED IN OUR OFFICE WITH THE ORIGINAL PRESCRIPTION LABELED CONTAINER IN ACCORDANCE WITH THE MANUFACTURER INSTRUCTIONS.Please do NOT leave any medication or EPI-PENS in your child’s bag or with their instructors. *CHILDREN WILL NOT BE ALLOWED TO PARTICIPATE AT SILTON UNLESS ALL REQUIRED DOCUMENTATION IS FULLY COMPLETE AND IN OUR OFFICE.

Please either mail-in, drop off, email, or fax your required documentation to us prior to your child’s first day.

SILTON.MEDICAL@gmail.com / Fax: 732-223-0288

For Students with Type 1 or 2 Diabetes:

Please provide us with your child’s DIABETES MANAGEMENT PLAN and complete the above Complex Medical Form.