By my signature, below, I hereby give these permissions to medical personnel selected by the camp director: Order X Rays, routine tests, or other treatment; release any records necessary for insurance purposes; release a diagnosis and prescription to camp staff; and/or provide/arrange any related transportation necessary for my child.
If I am unreachable, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization. This completed form may be photocopied for trips out of camp. Both sides of this form are correct and complete to the best of my knowledge, and the camper herein described has permission to engage in all camp activities, except as may be noted on this form.