AGREEMENT WITH PARENT OR GUARDIAN AND MEDICAL RELEASE

  NOTE:  A parent or guardian must complete one of these forms for each child under 18 who is attending camp unaccompanied by the parent and return it with his/her registration form.  This is to be filled out by parent or guardian and signed by both parent and child.  By signing this agreement, both parent and child are affirming that the child will abide by all camp rules and regulations; will attend all sessions unless sick; will respect the person and property of other campers; and will cooperate with the couselor(s) of his/her group.  In the event the child refuses to abide by this agreement, the parent or guardian may be called and asked to come and take the child home immediately.

            1.            Name of child____________________________________

            2.            Your name_______________________________________

                        Telephone Number (______)_________________________

                                                     (area code)

            3.            Child will arrive __________________ By ______________

                                                                                             (car, bus, etc.)

In case of an emergency, I understand every effort will be made to contact me.  In the event I cannot be reached, I hereby give my permission to the physician selected by the camp director to hospitalize and secure proper treatment (including surgery) for my child.

My child can take all medications ______ yes  ______ no.

My child cannot take the following medications:______________________________

__________________________________________________________________

__________________________________________________________________

Please list any allergies of applicant: _______________________________________

__________________________________________________________________

______________

         (date)           

(signature of parent or guardian)                      (signature of child)