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2010 Medical Release:Please print form, be sure to sign and send to camp. If possible, it should be sent prior to the camp week. Camp Witness Release Form Camper
Name: __________________________________
I the undersigned parent/guardian of the individual named above, a minor,
do hereby agree to allow participation in the camp(s) for which my child has
been registered and authorize and appoint the directors and staff of Camp Witness as Attorneys in
Fact and agents for the undersigned to consent to medical, surgical and/or
dental examinations, in addition to any and all other treatments that may be
deemed necessary by medical personnel. It is understood that participation
involves an element of risk and a danger of accidents. Knowing those risks, I
hereby assume those risks. I give my permission
for my child to participate in all program activities. I give permission, in the event of an emergency, for first
aid to be administered to my child, and should it be necessary, for emergency medical
treatment, which may include transportation by ambulance to the nearest
hospital. I understand that every effort will be made to contact me prior to
treatment. In additional, I
understand that by signing this agreement, I hereby release and discharge Camp
Witness Bible Conference Association from any and all liability resulting in
injury associated with the camper’s participation I this activity. I
understand it is my responsibility to inform camp personnel of any medical
conditions, allergies, food restrictions or any other special needs my
son/daughter may have. In the absence of a parent/guardian’s signature below,
payment of fees and participating in the program shall constitute acceptance of
the conditions set forth in this release.
I give permission to allow photos and
video of my child to be taken during camp. I further give permission that these
photographs may be published and used by Camp Witness to promote camp programs. Parents Name Printed:
___________________________ Signed:
_________________________________________ Date:
____________________________ Return this form with payment if paying by check. Mailing Address
Camp Witness HCR 62 Box 30B Long Pine NE 69217 402 273 4352 Please send this form with camper if paying Online. |
