I, the undersigned   First Name*Last Name*   , am the parent or legal guardian of the child/youth named   First Name*Last Name*   , who was born on   Date of Birth*  and resides in   Street Address *City*State*Zip*    . For any situation, I assure that I will be available for the phone call at      Area Code*Phone Number* As a parent or legal guardian, I affirm that I have read the CM rules and understand the activities that my child/youth will participate. I understand that my child will participate in Summer Camp activities such as group and individual sports, swimming, bonfires, church youth services, and other summer camp activities/programs. I affirm that I understand the general structure of the activities/programs and do not need to be informed of each and every activity. I certify that my child is free from the following conditions/diseases: Covid19, Measles, Mumps, Chicken Pox, & known heart conditions. My child does have the following known conditions: Sinusitis   Bronchitis   Diabetes   Asthma   Allergies    
 Allergies Include:   Insect StingPollenNutPoison Ivy, OakSoyWheat,   Other Allergies.  I agree to send my child with the proper, Doctor prescribed medications to treat his/her conditions. I agree to provide the Doctor's note with instructions for my Childs treatment for the week. I give the directors/camp nurse authority to give medicines/treatments as directed by my Childs doctor. I will also send my child with the appropriate marked over-the-counter medications and vitamins. No unmarked bottles will be allowed.
In addition, I hereby voluntarily release, forever discharge the community, the campground, its officers, Camp Mission directors, volunteers and workers of Camp Mission, Mission to Ministry, Yellow Creek Lake Ministries Campground & Bethel Tabernacle Church of God from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form on    Date, I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.