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Day Camp 2010 Medical Release

This document is a medical release form for a child attending St. Paul Lutheran Church's 2010 summer day camp. It delegates the parents' legal authority to consent to healthcare for their child to the church from June 14-18, 2010. The form collects the child's name, allergies, medications, and medical conditions. It also notes that transportation will be provided to afternoon events and photographs may be taken for the website, with an option to discuss concerns with directors or the pastor.

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39 views

Day Camp 2010 Medical Release

This document is a medical release form for a child attending St. Paul Lutheran Church's 2010 summer day camp. It delegates the parents' legal authority to consent to healthcare for their child to the church from June 14-18, 2010. The form collects the child's name, allergies, medications, and medical conditions. It also notes that transportation will be provided to afternoon events and photographs may be taken for the website, with an option to discuss concerns with directors or the pastor.

Uploaded by

api-26565051
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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DAY CAMP 2010 MEDICAL RELEASE

I/we, _____________________________________________________________ as parent(s)


of ________________________________________________________(child's name) delegate
my / our legal authority to consent to healthcare on behalf of such child to St. Paul Lutheran
Church (Borchers). This delegation is to be exercised in good faith and in the best interest of
my / our child. This delegation is effective June 14, 2010 up to and including June 18, 2010.

Signature of Parent(s): _________________________________________ Date: _____________

Medical Information
Child's name: _______________________________________________
Allergies: ________________________________________________________________________
Present medications: _______________________________________________________________
Any medical condition(s) physician should know about: ____________________________________
_________________________________________________________________________________

PLEASE NOTE THE ATTACHED SHEET OF AFTERNOON EVENTS. TO


ENCOURAGE FAMILY TIME, WE ARE ASKING THAT AN ADULT BE
PRESENT FOR YOUR CHILD BEGINNING AT THE EVENING MEAL.

Transportation will be provided Tuesday-Thursday to the afternoon events. If your child


is going in the afternoon please let the person signing them in know!

Photographs may be taken of your child for use on our website. If you have a concern
with this please talk to one of the directors or the Pastor.

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