NOTE: Please be prepared to review the medications and prescriptions with the staff if needed.
PERMISSION TO ADMINISTER OVER-THE COUNTER MEDICATIONS
For checks and cash - Drop off at the REACH 907 office located at the Mat-Su Health Foundation building at 777 N Crusey St, Suite #B109, Wasilla. Slide payment under the door if we are not in. Make checks payable to REACH 907.
For credit cards, call us at 907-982-9645
Contact Executive Director Rachel Olson at 907-982-9645 or email@example.com for more details.
Informed Consent and Acknowledgement
I hereby give my approval for my youth’s participation in any and all activities during the selected camp. In exchange for the acceptance of said youth’s candidacy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless REACH 907, Royal Family KIDS, INC (RFK), TeenReach Adventure Camp (TRAC), and all its respective officers, agents, and representatives from any and all liability for injuries to said youth arising out of traveling to, participating in, or returning from selected camp sessions.
In case of injury to said youth, I hereby waive all claims against REACH 907, RFK, and TRAC, including all affiliates, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all camp activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named child(ren), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child(ren), in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life(lives), physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination, and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to REACH 907 and its affiliates including Directors and Staff to provide the needed emergency treatment prior to the youth’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered season.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child(ren), in my absence.
During camp, prescription medication will be administered to youth as directed by a physician. REACH 907 will do everything in its power to prevent incorrect medicine from being given. However, the local REACH 907, RFK, and TRAC, are not liable for incorrect medicine provided to us by the legal guardian, incorrect dosages given, nor is it liable for wrong labeling on medicine bottles. Legal guardians are responsible for checking in the correct medication, bottles, and dosages at the time of registration. This is not the time to give medication vacations to your youth.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM COMMITTING TO A REACH 907 PROGRAM FOR A CHILD IN MY CARE.
I ACKNOWLEDGE THAT REACH 907 IS A FAITH-BASED ORGANIZATION OPERATING A FAITH-BASED CAMP PROGRAM.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AND BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.