Initial* All PRESCRIBED medications must be in their ORIGINAL containers with current directions as indicated by a physician. We will NOT ACCEPT medications in ANYTHING other than the original container. If it is not in the original container, you will be asked to bring the original container to us.Initial* Please ensure all immunizations are current, or we have received your exemption form, and you have informed us of all ALLERGIES TO FOOD AND MEDICATIONS during the registration process.Initial* OVER-THE-COUNTER MEDICATIONS (OTC): Please note the camp has a well-stocked infirmary. It is generally unnecessary to send routine over-the-counter medications with your child. If your child’s OTC medication is unavailable and you bring his or her own supply, please leave it in the original container and label it with your child’s name.
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.
Informed Consent and Acknowledgement
I do hereby relieve and hold harmless New Beginnings Christian Camp and staff thereof, from any and all liability for sickness (including Covid-19 exposure or infection), accidents, or injuries of any cause whatsoever while my child is in attendance at, or traveling to or from, camp property.
I do hereby agree to pay all costs required to attend camp. I understand that no refunds of all or any part of the full registration fee will be made, unless my child’s participation in the camp session is terminated for medical reasons as ordered by a physician or the leaders of New Beginnings Camp determine the session must be cancelled due to Covid-19. I further understand that New Beginnings Camp retains a degree of financial obligation to Camp Akiva even in the case of cancellation due to Covid-19. If the leaders of New Beginnings camp determine that the 2023 camp session must be cancelled due to Covid-19, a portion of my registration fees may be retained by New Beginnings Camp to meet their financial obligation to Camp Akiva. I agree to abide by the rules and policies of camp management, including any extra measures (before and during camp) for limiting exposure to Covid-19.
Permission is hereby granted for photographs and videos to be taken of camper, and for any photographic image, likeness, or depiction of camper to be used at any time, in whole or in part, without restriction as to changes or alterations to the image, by New Beginnings Christian Camp and staff thereof, for any purpose and in any medium now or heretofore known, including print and electronic. I further waive any claim for compensation for said use of photographic images.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.