RFKC Teen Volunteer Medical Release

I hereby give the Royal Family KIDS Camp Nurse/Medical Professional permission to administer the following products according to manufacturer's instructions, or as otherwise specified. I trust the RFKC Nurse/Medical Professional to use their best judgment as situations arise, and if in doubt, they can call for verification. Please check Y (yes) or N (no) for the medications listed below.

This healt history is correct so far as know. and the above named minor has permission to engage in at prescribed program activities, except as noted The undersigned do hereby authorize the directors of Royal Kids Camp or such substitute as they may designate as agent for the undersigned to consent to an X-Ray examination anesthetic. medical. dental or surgical diagnosis or treatment and hospital care for the above minor whichis deemed advisable by and to be rendered under the general or special supervision of any physician and surgeon, licensed under the provision of the Medicine Practice Act or any dentist licensed under the Dental Practice Act. whether such diagnosis or treatment is rendered at the office of said physician or dentist. at a hospital, camp or elsewhere This authorization will remain effective while the above minor is enroute to and from or involved or participating in any camp program, unless revoked in writing by the undersigned and delivered to the Director of Royal Family as legal guardian/ socialworkerlother. I give my permission for{firstName}{lastName}to attend Royal Family Kids' Camp in the summer of 2024 through Calvary Church.