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Search for:
Home
Congregations
Events
Calendar
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Ministries
Regional Minister Search
Commission on Ministry
Clergy Standing Renewal Form
Clergy Standing Transfer Form
In-Care Request Form
Praying for our In-Care Candidates
Lane Salmon and Clergy Scholarship Funds
Global Ministries
Colombia Partnership
Special Offering for 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 and Reference Forms- Printable
Resources
For Clergy
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Clergy Standing Renewal
Clergy Standing Transfer Form
Lane Salmon and Clergy Scholarship Funds
2020 Clergy Boundary Training- Insurance Board Track
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
DMF Special Day Offerings
Visitors
Staff
Values and Mission
More About the Disciples
Job Opportunities
Donate Here
Northern Lights Annual Fund
Disciples Mission Fund
Donations for Congregations
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
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Ministries
Regional Minister Search
Commission on Ministry
Clergy Standing Renewal Form
Clergy Standing Transfer Form
In-Care Request Form
Praying for our In-Care Candidates
Lane Salmon and Clergy Scholarship Funds
Global Ministries
Colombia Partnership
Special Offering for 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 and Reference Forms- Printable
Resources
For Clergy
Clergy Healthy Boundaries & Anti-Racism/Pro-Reconciliation Training
Clergy Standing Renewal
Clergy Standing Transfer Form
Lane Salmon and Clergy Scholarship Funds
2020 Clergy Boundary Training- Insurance Board Track
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
DMF Special Day Offerings
Visitors
Staff
Values and Mission
More About the Disciples
Job Opportunities
Donate Here
Northern Lights Annual Fund
Disciples Mission Fund
Donations for Congregations
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
*
2022 Kids Camp @ Gwinwood
2022 Kids Camp @ Cane Ridge West
2022 Junior Camp @ Gwinwood
2022 Junior Camp @ Cane Ridge West
2022 Chi Rho Camp @ Gwinwood
2022 Chi Rho Camp @ Cane Ridge West
2022 CYF Camp @ Gwinwood
2022 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:
*
Email
Submit
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