Consent to Participate and Authorizations
I hereby permit my child to attend and participate in all programs and activities provided by Camp Administrator, throughout the duration of his/her stay, except for activities exempted on the Medical Examination Form.
I hereby authorize the Camp Administrator physician(s), or his/her authorized representative, to furnish or arrange for any medical and/or hospital care the above-named camper might require during such time as he/she is at the camp. I hereby authorize Camp Administrator and/or hospital physicians, nurses, hospitals, and their authorized personnel employed, contracted, paid on a fee basis or volunteer to perform all treatments and procedures as deemed necessary; this medical care may include, but not be limited to, examinations, treatments, immunizations, injections, anesthesia, surgery, and other procedures.
I hereby authorize the release of medical records possessed by Camp Administrator to physicians, nurses, hospitals and their authorized personnel for the performance of treatments and procedures as deemed necessary upon my child. I understand that Camp Administrator will make a diligent effort to notify me if a medical emergency occurs and that I will receive a report of the treatment(s) and/or medication(s) given to the above-named camper.
The payment of medical costs incurred for treatment of medical conditions, illnesses or accidents while participating in Camp Administrator programs including but not limited to the purchase of any medications/prescriptions, hospitalizations and/or other medical care secured for the treatment of my child, that are not covered by the camper’s personal insurance, and the cost of such personal insurance coverage, is the responsibility of the camper and his/her parent/ legal representative. I understand that my insurance company may be billed for medical services provided to my child by medical personnel while he/she attends the camp.
In following OSHA guidelines of tissue and body fluid contamination, should an exposure of blood or other potentially infectious bodily fluids occur, including needle sticks, Camp Administrator obtains blood testing of individuals involved in the exposure. In the event my child is a party to an exposure of blood or other potentially infectious bodily fluids, including a needle stick, either as the individual receiving the exposure, or the person whose blood or potentially infectious bodily fluids were exposed to another, I hereby authorize Camp Administrator to have blood testing conducted on my child and do hereby grant approval for the results of such testing to be made available to Camp Administrator and to the party(s) involved in the exposure.
Camp Administrator is not responsible for personal items lost, misplaced, broken or otherwise damaged. Camp Administrator reserves the right to send a camper home if illness or other significant reason so dictates.
The undersigned hereby acknowledges that the activities and programs of Camp Administrator are potentially dangerous and there is risk of physical injury. In consideration for allowing my child to participate in the activities and/or programs of Camp Administrator, and use their premises, or the premises of their affiliated program partners, I hereby release and forever discharge Camp Administrator, their agents, officers, directors, employees, and volunteers, and all other persons or entities liable or claimed to be liable, and agree to indemnify and hold harmless from any and all claims, demands, damages, suits or injuries whatsoever arising from or related to my attendance, or the attendance of my child/family, at activities and/or programs of Camp Administrator.
Furthermore, the undersigned, parent/ legal representative if person(s) named on this form is/are minor children, acknowledge that they have read, understood, agree with and consent to the above policies of Camp Administrator.