x| | | | |
13 | " | | | | | | |
------|------|------|------|---------|---------|-------|------|-------
20 | " | | | | | | |
------|------|------|------|---------|---------|-------|------|-------
27 | " | | | | | | |
------|------|------|------|---------|---------|-------|------|-------

[Illustration: C. Tent Chart for assigning reservations]

Health Certificate

[Illustration: HEALTH CERTIFICATE

The following must be filled out by a physician _within three days_ of
the time the girl enters camp. It should preferably be done by someone
who has known her for some time. The object of this certificate is: (1)
to safeguard child and others against contagious diseases; (2) to make a
basis for judging the suitability of camp life for her, and make
possible any necessary precautions, particularly in regard to exercise.

I, .........................................................
have this day,......................,19 personally examined
............................................................
........years, of................................,.........,
and believe the following to be a complete statement as to her
health and bodily condition:

_Contagious disease_: State child's condition and whether she has been
exposed and if any quarantine is necessary.

_Nutrition_: Excellent Good Fair Poor Very Poor
_Anemia_: Hemoglobin content:
_Prepubertal_ or _postpubertal_. Menstruation: Established
Any disturbance?

_Eyes_: R L Glasses? _Ears_: R L
_Nose_: _Throat_: _Teeth_:
_Muscles_:
_General Nervous System_:
_Stomach_: _Bowels_:
_Skin_: _Head_: _Skeletal_: Back
Feet
_Temperature_:
_Heart_: Rhythm: Sounds: Any disturbance?
_Blood Pressure_: Systolic: Diastolic: Compensation:
_Lungs_:

As a general summing-up of recommendations in regard to whole
condition outlined above, I recommend the following:

1. Diet:
2. Rest:
3. Exercise:
a. Should keep quiet.
b. Can exercise moderately.
c. Any reasonable exercise.
d. Can take heavy exercise.
e. Can (cannot) walk swim run jump
climb
4.