I understand the Downingtown Area School District, its staff and employees, and the Cougar Cheer Staff are not responsible for any accident or injury occurring to (add campers name) First Name* Last Name* . Parent's Signature: Signature* Please list any pertinent medical information of which our nurse or staff should have knowledge. (Allergies or Health Issues, type N/A for none) Allergies or Health Issues* Authorization to Consent to Medical Treatment for a Minor Child I (Parent/guardian) First Name* Last Name* , state that I am the natural parent and /or have legal custody of (Child's Name) First Name* Last Name* .I give permission for my child to receive Tylenol Signature* or Benadryl Signature* , if necessary. I authorize the head coach, nurse & or camp director, to consent to any examination, anesthetic, x-ray, medical or surgical diagnosis or treatment, and/or hospital care to be rendered to this minor under the general conditions of special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me are unsuccessful. Parent/Guardian Name First Name* Last Name* Parent/Guardian Signature Signature* Medical Insurance Carrier Insurance Carrier* Policy# policy number* Emergency Contact: First Name* Last Name* Relationship to Camper: relationship* Emergency Contact Phone Number: Area Code* Phone Number*