I, being the parent or guardian of (Camper Name, entered above) , do hereby authorize appointed staff of Camp New Hope to administer all medicines, prescription drugs, and other medical remedies required for or on behalf of the above named person, while said person is participating in or at Camp New Hope function.
I specifically agree to advise the staff and personnel of Camp New Hope of all prescribed and over the counter medicines which are needed for the above named person.
Permission to Treat
I hereby give permission to the medical personnell selected by the staff at Camp New Hope, to provide routine health care; to administer medications; to order X-rays, routine tests; treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for above named person.
In the event of an emergency in which I cannot be reached, I hereby give permission to the Emergency Personnel or physician selected by the staff at Camp New Hope, to secure and administer treatment, including hospitalization, for the above named person.
I further waive any claim on behalf of myself and the above named person pursuant to the authorization. I further warrant that I have the authority to grant this medical authorization on behalf of the above named person. Furthermore, I agree to hold Camp New Hope harmless by reason of my execution of this medical authorization and permission to treat.
This completed form may be photocopied for trips outside of Camp New Hope.