Informed Consent and Acknowledgement
We Hereby Consent
1. We consent and authorize the All Saints Summer Camp to provide treatment whether en route, on, or off the camp grounds for any first aid whether routine or emergency, including, without limitation, injury, illness, choking, etc.
2. We and each of us consent and authorize All Saints Summer Camp
Camp instructors to provide treatment, including cardiopulmonary resuscitation (CPR) in the event of a water sports accident or other need.
3.If we parents/guardians cannot be reached in case our child had an emergency or other medical need, we and each of us hereby appoints, authorizes, and constitutes the All Saints Summer Camp Director, Camp Health Officer/ Nurse/ Doctor, or other duly authorized staff member to act in our behalf as parents to authorize and consent to medical treatment for our child/ren named herein:
including authorizing surgery. In case of need, we authorize any family or specialist physician, dentist, or other licensed health care professional, and also any licensed health care facility to provide any and all necessary treatment to our child.
The below consent and authorization includes routine, emergency, inpatient, and outpatient care. Any health care professional or health care facility is authorized to accept and rely on the All Saints Summer Camp Staff's representation if we cannot be reached. The original form shall be displayed to a health care provider, but this original shall remain in the custody of the Camp Director.
In addition, I agree that in the case of a health or accident emergency, or any other situation which might arise en route to and from camp, or while attending camp, that none of the facilitators, staff or sponsors of the All Saints Summer Camp including but not restricted to The Orthodox Church in America, The Diocese of the South, St. Seraphim Orthodox Cathedral, Holy Nativity of the Lord Mission or its staff, volunteers or representatives will be held liable in any way.
The undersigned acknowledges that, during participation at All Saints Summer Camp, at the site of Akiva Camp, and at other facilities used for supervised camp-related activities, certain risks and dangers may occur. These include, but are not limited to, loss or damage to personal property, physical or psychological damages and/or injury, not excluding fatality, due to accidents, which may occur. I also acknowledge that participants may be transported off the camp for supervised camp-related activities.
In consideration, and as a part of the right to participate in this All Saints Summer Camp
Program, I have and do hereby assume all of the above risks and any other ordinary risk incidental to the nature of these activities which are not specifically foreseeable, and will not hold liable the Orthodox Church in America, the Diocese of the South, All Saints Summer Camp, St. Seraphim Orthodox Cathedral, Holy Nativity of the Lord Mission, Volunteers, Agents or Participants. I agree that any person/s providing service to the Camp, harmless from any and all liability actions, causes of
action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, which may arise in connection with any participant's activities and participation in All Saints Summer Camp.