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Search for:
Home
Congregations
Events
Calendar
Ministries
Regional Minister Search timeline
Regional Profile
Regional Minister job description
Commission on Ministry
Clergy Standing Renewal Form (PRIINT)
Clergy Standing Transfer Form
In-Care Request Form
Praying for our In-Care Candidates
Lane Salmon and Clergy Scholarship Funds
Global Ministries
Colombia Partnership
Congregational resources – Colombia
Support our mission coworkers
New Church Ministries
Regional Board
Financial Reporting
Transformation Ministries
Youth and Children’s Ministries
Outdoor Ministries
Summer Camps
Adult Volunteer Application
Adult Volunteer Reference Form
Adult Volunteer Application & Reference Forms – Printable
Adult Volunteer Emergency/Medical Info Form
Resources
Northern Lights Regional Profile
For Clergy
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Clergy Standing Transfer Form
Clergy Standing Renewal (PRINT)
Lane Salmon and Clergy Scholarship Funds
Job Opportunities
Denomination & Ecumenical Partner Links
Christian Church (Disciples of Christ)
Disciples Home Missions
Disciples Regional Ministries
Disciples Racial-Ethnic Ministries
Disciples Church Extension Fund
Disciples of Christ Historical Society
Hope Partnership Services
The Center for Faith and Giving
Green Chalice
Global Ministries
National Benevolent Association
Week of Compassion
Pacific NW Conf. United Church of Christ
For Congregations
Grants Policy
Search and Call Committee Resources
Church Treasurer Handbook
DMF Special Day Offerings
Visitors
Staff
Values and Mission
More About the Disciples
Job Opportunities
Donate Here
Annual Fund – Northern Lights
Gwinwood Retreat Center
Gwinwood Fire Recovery
Gwinwood Operations
Amazon Wish List
Disciples Mission Fund
Global Ministries Mission Coworkers Alex & Xiomara
Lane Salmon/Clergy Scholarship Funds
Newsletter
Submit news for Community Connections
Regional News Opt-in
Home
Congregations
Events
Calendar
Ministries
Regional Minister Search timeline
Regional Profile
Regional Minister job description
Commission on Ministry
Clergy Standing Renewal Form (PRIINT)
Clergy Standing Transfer Form
In-Care Request Form
Praying for our In-Care Candidates
Lane Salmon and Clergy Scholarship Funds
Global Ministries
Colombia Partnership
Congregational resources – Colombia
Support our mission coworkers
New Church Ministries
Regional Board
Financial Reporting
Transformation Ministries
Youth and Children’s Ministries
Outdoor Ministries
Summer Camps
Adult Volunteer Application
Adult Volunteer Reference Form
Adult Volunteer Application & Reference Forms – Printable
Adult Volunteer Emergency/Medical Info Form
Resources
Northern Lights Regional Profile
For Clergy
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Clergy Standing Transfer Form
Clergy Standing Renewal (PRINT)
Lane Salmon and Clergy Scholarship Funds
Job Opportunities
Denomination & Ecumenical Partner Links
Christian Church (Disciples of Christ)
Disciples Home Missions
Disciples Regional Ministries
Disciples Racial-Ethnic Ministries
Disciples Church Extension Fund
Disciples of Christ Historical Society
Hope Partnership Services
The Center for Faith and Giving
Green Chalice
Global Ministries
National Benevolent Association
Week of Compassion
Pacific NW Conf. United Church of Christ
For Congregations
Grants Policy
Search and Call Committee Resources
Church Treasurer Handbook
DMF Special Day Offerings
Visitors
Staff
Values and Mission
More About the Disciples
Job Opportunities
Donate Here
Annual Fund – Northern Lights
Gwinwood Retreat Center
Gwinwood Fire Recovery
Gwinwood Operations
Amazon Wish List
Disciples Mission Fund
Global Ministries Mission Coworkers Alex & Xiomara
Lane Salmon/Clergy Scholarship Funds
Newsletter
Submit news for Community Connections
Regional News Opt-in
Camp Medical Incident Report
Camp Medical Incident Report
northernlightsdisciples
2021-07-08T11:38:51-07:00
Please enable JavaScript in your browser to complete this form.
Major Medical Incident Report
Please use this form in cases where more than basic First Aid was required to resolve health complaint or injury. This can include concussions, allergic reactions, hospital trips, etc. These details can be used for future reference, follow up with parents/guardians, and/or communication with insurance companies. Thank you for being thorough.
Date / Time of Incident
*
Date
Time
Participant's Name
*
First
Last
Event
*
Kids Camp @ Gwinwood
Kids Camp @ Cane Ridge West
Junior Camp @ Gwinwood
Junior Camp @ Cane Ridge West
Chi Rho Camp @ Gwinwood
Chi Rho Camp @ Cane Ridge West
CYF Camp @ Gwinwood
CYF Camp @ Cane Ridge West
Was the Parent/Guardian/First Emergency Contact able to be reached and included in treatment decisions?
*
Yes
No
Second Emergency Contact was used.
Incident Details
*
Example: Camper fell while playing soccer in the upper field at free time. Camper friends X, Y, and Z carried injured camper back to the lodge for examination.
Treatment
*
Example: Attempted First Aid of ice and elevation and administered OTC Advil. Swelling and pain continued. Emergency Contact agreed Urgent Care visit was warranted and camper was transported by Adults X and Y. Examination and X-ray show no fracture, bad sprain. Parent/Guardian and camper elect to continue attending event with proper medical support (ice, pain relievers, support bandage) and modified activities.
Medical Reports
Click or drag a file to this area to upload.
If available, please scan any paperwork or reports received at the time of Urgent Care/Hospital treatment.
Other Notes
Please use this area to add any other commentary you think is helpful for the records.
Your Name and your Role at this event:
*
Comment
Submit
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