Medical Release and Authorization
I, the undersigned Parent/Guardian of the above-named Camper, give permission for the medical staff at New Beginnings Christian Camp TO DISTRIBUTE PRESCRIPTION MEDICATIONS AND PERSONAL SUPPLIES OF OVER-THE-COUNTER MEDICATIONS to said Camper as outlined above.
I, the undersigned Parent/Guardian of the above-named Camper, give permission for the medical staff at New Beginnings Christian Camp TO DISPENSE OVER-THE-COUNTER MEDICATIONS OUT OF THE INFIRMARY to said Camper as they see fit.
The infirmary also has prescription epi-pens and/or albuterol for use in emergency situations. I, the undersigned Parent/Guardian of the above-named Camper, give permission for the medical staff at New Beginnings Christian Camp TO ADMINISTER PRESCRIPTION EPI-PEN AND ALBUTEROL to said Camper in the event of a respiratory emergency and/or severe allergic event.
As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, 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, 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 camper. 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 the New Beginnings Camp and its affiliates, including Directors and staff, to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered camp session.
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, in my absence.