In the event reasonable attempts to contact me or either alternate have been unsuccessful, I hereby give my consent for:
1. the administration of any treatment deemed necessary by my above listed physician or dentist, or in the event the designated practitioner is not available, by another licensed physician or dentist
2. the transfer of the child to the above listed hospital or any hospital reasonably accessible.
This authorization does not cover major surgery unless the medical opinions of two other licensed physcians or dentists, concurring in the necessity of such surgery, are obtained prior to the performance of such surgery.
By typing my full name below I agree that I am responsible for the cost of any and all medical treatment for my child as well as emergency transportation.
I also agree to release, hold harmless, and indemnify Camp Country Day, Canton Country Day School, its agents, representatives, and employees from all claims, damages or other liabilities or injuries to my child which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by the Camp, School, or its agents, representatives, or employees.
I hereby give permission for the Camp or School to administer first aid to my child when necessary and authorize the Camp or School to release any medical information the school has on file to a treating physician.
IMPORTANT: Please notify us immediately if any of the informaiton on this form changes.