As a parent and/or guardian, I do herewith give permission for my student to participate in Middle School Winter camp at Clear Lake Grace Brethren Camp in January 2018. I authorize treatment under the direction of any licensed physician of the above named minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the number listed above.
I assume the responsibility for any costs connected with such treatment and herby release Hope Community Church from any liability.
This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.