Medical Release and Authorization
As Parent and/or Guardian of the named camper, I hereby authorize the Dean of Camp, or the Dean’s adult appointee, as agents for the undersigned, to consent to any examination, anesthetic, medical or surgical diagnosis and/or treatment and hospital care which is deemed advisable by, and is rendered under the general or specific supervision of any surgeon and physician who is licensed under the provisions of the Medical Practice Act and is on the medical staff of any accredited hospital. It is understood this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of my/our aforesaid agents to give special consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is further understood that all effort will be made to contact the parent(s) or legal guardian prior to the use of this authorization.
I do hereby authorize the SALCA Camp Nurse, or other designated SALCA representative to perform any necessary minor first aid procedures and dispense medications as deemed appropriate unless specifically forbidden by me/us in writing.
I agree to release and hold harmless the SALCA Camp Nurse or other designated SALCA representative from any liability arising from my child treatment.
This authorization shall remain effective from May 27-31, 2019 for SALCA summer camp; unless revoked in writing and delivered to said agents.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.