I, your name hereby give permission for my child to receive medication or recieve treatment with an Epi Pen or Astma Inhaller at Easts Basketballs Basketball camp as prescribed in this Medical Management Plan. Medication and equipment must be provided in its original prescription container properly labelled by a pharmacist or physician. I also give permission for the release and exchange of information between Easts Basketball Staff and my child’s health care provider concerning my child’s health and medications. In addition, I understand that this information will be shared EBL Staff on a need to know basis. I give permission for my child to self-administer medication, as prescribed in this Management Plan. I consider him/her to be responsible and capable of transporting, storing and self-administration of the medication. Medication must be kept in its original prescription container. I understand that EBL does not have anywhere to store medication. I understand staff shall incur no liability as a result of any condition or injury arising from the self-administration by the Camper of the medication prescribedon this form. I indemnify and hold harmless Easts Basketball, its coaches & Staff against any claims arising out of self administration or lack of administration of this medication by the Camper First Name Last Name