Heartland Hockey Camps 24921 Arena Dr. Deerwood, MN 56441 218-534-3298 out of state residents (800) 945-7465 Fax (218)534-3297 Medication Plan Name
________________________________________________ Allergic
to any Medications
YES NO If so what?
_____________________________________________________________ MEDICATIONS Daily _____________________________________________________________________________________ Breakfast _____________________________________________________________________________________ Lunch _____________________________________________________________________________________ Dinner _____________________________________________________________________________________ IN AN EMERGENCY DOCTOR
______________________ PHONE
_________________ ADDITIONAL INFORMATION ___________________________________________________________ |