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  • Medical and Media Release Form

    Permiso de tratamiento medico y fotografia de niño
  • Electronic Signatures. The parties acknowledge and agree that this permission and medical release form may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. Without limitation, “electronic signature” shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature./Firmas electrónicas. Las partes reconocen y acuerdan que este permiso y formulario de autorización médica pueden formalizarse mediante firma electrónica, la cual se considerará firma original a todos los efectos y tendrá la misma validez y efecto que una firma original. Sin limitación, se entenderá por «firma electrónica» las versiones enviadas por fax de una firma original o las versiones escaneadas y transmitidas electrónicamente (por ejemplo, en formato PDF).

  • Child Information

    Información de niño(s)

  • If signing up more than 1 child:

    Si tiene mas que un niño/a

  • Parent/Emergency Contact Information

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  • Medical Information

    Información medica de niño
  • Does the participant require a special diet?/¿Su hijo necesita una dieta especial?*
  • Does the participant have any allergies?/¿Su hijo/a tiene alergias?*
  • Is the participant taking any medication or over-the-counter (OTC) drugs?/¿Su hijo/a está tomando algún medicamento?*
  • Can the participant self-administer his or her medication?/¿Su hijo/a puede administrarse sus propios medicamentos?

  • Physical Conditions that limit activity

    Condiciones físicas que limitan actividades
  • Does the participant have a chronic or recurring illness?/Participante tiene alguna enfermedad crónica o recurrente*
  • Has the participant had surgery or a serious illness in the past year?/Participante a tenido cirugía o una enfermedad grave en el último año*

  • Signature

    I give permission for my child/youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event. The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp, or event safety rules and other pertinent instructions. Participants’ conduct and interactions should abide by Church standards and exemplify Christlike behavior. Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if they behave inappropriately or if they pose a risk to themselves or others.
  • Parent or Guardian photo consent*

  • Your child will be given the opportunity to opt-out of group photos. Please make sure they are aware that they should not participate in photo opportunities. 

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