I, the undersigned, certify that I am the parent or legal guardian of: ___________________________ Age _______ SS#: __________ _ (Hereafter the "minor child"). I hereby give my consent to have my minor child participate in all activities ofEFCCA: 2022 Summer Camp (Hereafter "the activity"). I recognize that there may be risk involved in participating in these activities and hereby assume all risk injury, harm, damage or death to my minor child in connection with his/her participation in this activity. To the fullest extent pennitted by law, I release EFCCA and all representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless EFCCA and all representatives from any claims arising out of my minor child's participation in the activity. further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the school or organization sponsoring this event will be used as the secondary coverage. By signing below, I state that I have read and will follow the rules set forth by EFCCA, and I understand this consent fonn and agree to its conditions. Parent or Legal Guardian Signature:-------------------------------------- Printed Name:---------------------------------------------- Camp Directors Signature:-----------------------------------------
EFCCA welcomes families without regard to gender, race, religion, national origin, cultural heritage, political beliefs, family lifestyle, marital status, sexual orientation or disability.