This health history is correct so far as I know, and the above named minor has permission to engage in all prescribed program activities, except as noted. The undersigned do hereby authorize the volunteer directors, nurses, and physicians of Royal Family KIDS Camp, or such substitute as they may designate, as agent for the undersigned to administer the above medication and consent to an X-Ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above minor which is 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. Specifically, I requst the above minor be assisted by camp medical personnel in taking the above prescribed medications and to provide the above minor with Tylenol, Tums, Motrin, and Benadryl as deemed necessary by camp and medical personnel. I give consent for camp medical personnel to communicate with the above minor's doctor if deemed necessary by camp and medical personnel. I agree to hold harmless the volunteer medical personnel who provide care for the above minor. This authorization will remain effective while the above minor is en route 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 KIDS as legal guardian/social worker/other. I understand that it is my responsibility as caregiver to make sure all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp.