Permission and Medical Consent
I understand that, in the event my child requires medical or dental treatment while attending Youth
Camp, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and
give permission to the event organizers and/or any adult counselor acting on behalf of the event, as agent for
me, to consent to any X-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and
treatment; and hospital care and treatment advised and supervised by a physician, surgeon, or dentist (as
appropriate) licensed to practice under the laws where the services are rendered, either as an outpatient or in
any hospital. To the best of my knowledge, I have listed above all of my child's medical allergies, medications
being taken, medical problems and other pertinent information. My child has permission to participate in all
prescribed activities unless otherwise noted by in this form.
In addition, I understand that counselors and staff of Youth Camp are not responsible for
injuries that may occur during the Activity. I hereby voluntarily waive any claim against these parties.