Medication authorization form

Please complete this form for all medications that will not be packaged through PackMyRX and all medications for Ruach Ramah campers.

This form is not for medications you are registering through PackMyRx. Please go through the PackMyRX registration process for all medications they are are able to pack.

Refer to the graphic below for which medications should go to PackMyRx and which would be shipped or brought to camp.

A separate form must be filled out for each medication.

By completing this form, you are giving Camp Ramah in Wisconsin permission to administer the medications/supplements in the form.

Questions? Email Scott Topal at stopal@ramahwisconsin.com

"*" indicates required fields

Camper Birthdate*
Frequency of Administration

Time of Day to Be Administered
Medication Administration Type*

How will you be sending the medication to camp?*
Note: Only oral contraceptives and Accutane may be sent with your camper. All other medications must be shipped.

I have read, understand, and will be compliant with the Camp Ramah in Wisconsin medication policy.

I understand that I am responsible for sending any of my child's medications/supplements not coming through PackMyRx so that it will arrive at camp prior to my child's session start date.

Date*