APPLICANT MUST BE 5-11 YRS. OF AGE for Elementary Camp

APPLICANT MUST BE 12-18 YRS. OF AGE for High School Camp

 

CAMPER T-SHIRT SIZE:

E-note for location and in case of Emergency

PHONE NUMBERS (include area code) - Please no "out of service" numbers.

EMERGENCY PHONE NUMBER - NOT parent numbers repeated.

DO HEREBY AUTHORIZE A REPRESENTATIVE OF THE OKLAHOMA SCHOOL FOR THE DEAF to consent to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to the above named minor under general or special supervision and upon the advice of a physician, surgeon or dentist licensed under the laws of the state of Oklahoma.

IN GIVING THIS CONSENT, I RECOGNIZE AND UNDERSTAND

that in situations where the above named minor requires immediate medical or hospital care, it may not be possible to contact me and that in such situations I will not be able to knowledgeably evaluate and choose among the available alternative treatments or procedures, if any, or to evaluate the risks attendant upon each and the risks attendant to foregoing all treatment. In such situations, I authorize a physician, surgeon, or dentist to exercise his professional judgment and assess the risks incident to and choose the necessary treatment from any available alternatives and to render such care and perform such treatment as he in his professional judgment determines to be necessary for the health or safety of the above-named minor.

I AUTHORIZE THE CONTRACT PHYSICIAN OR HIS DESIGNEE, IN CONJUNCTION WITH THE MEDICAL SERVICES STAFF, TO PROVIDE MEDICAL CARE FOR THE ABOVE-NAMED CHILD, A CAMP ATTENDEE AT THE OKLAHOMA SCHOOL FOR THE DEAF.DEAF.

OKLAHOMA SCHOOL FOR THE DEAF

STUDENT HEALTH CENTER

1100 EAST OKLAHOMA

Sulphur, Oklahoma 73086

(580) 622-4900 ext 4922 /4923

Health History:

Please provide details on any existing medical conditions, allergies, or special health considerations

1. Allergies (food, insects, medications, etc.):

2. Medications:

      - List all current medications, dosage, and frequency:

3. Chronic Medical Conditions (e.g., asthma, diabetes, epilepsy):

4. Immunizations:

    Provide dates for the most recent immunizations (MMR, Tetanus, etc.):

5. Others:

6. Previous Surgeries or Hospitalizations:

Physician Information:

Medical Insurance Information:

*Medical Release:*I hereby authorize the camp staff to administer over-the-counter medications (e.g., pain relievers, antihistamines) to my child if deemed necessary.

**Important Notes**- Please provide a copy of the child's health insurance card.- If the Child taking daily medications must bring the prescription bottles with the appropriate labels. and give them to the nurse on the registration day of the summer camp;- Please remember if the child is deemed too ill to function, they will have to go home, and you will be required to come pick the child up.