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Self-Administration of Medication Waiver

For Campers with Epi-Pens and Inhalers

This form is new to HoneyRock and is specifically for campers who use and/or carry an inhaler or epi-pen.

In the past, the Health Center checked in these medications and gave them to our camper’s counselor to carry. We are now giving you the option of having your camper retain possession of their inhaler or Epi-Pen.  If this is something that you wish for your camper, please print and fill out the form:

Epi or Inhaler Self Administration Form 2019

Please note that this form does require a parent AND physician signature. Please send completed forms to:

By Mail: ATTN: Nurse, 8660 Honey Rock Road, Three Lakes, WI 54562

By Email: honeyrock.nurse@wheaton.edu