Medical Release Form -  Sparks East Stake 2017

Medical Release Form - Sparks East Stake 2017

Girls Camp Medical Form Form Preview
Medical Release Form - Sparks East Stake 2017
  • Medical Release Form - Sparks East Stake 2017

  • Permission & Medical Release

    Date of Camp: July 17-22 2017

     

    I give permission for my child to participate in all Girls’ Camp activities including swimming, canoeing, hiking, camp duties, sports, obstacle course, and crafts.

    I give the Director and/or Staff of the Sparks Nevada Stake Girl’s Camp authority to administer treatment to my child for any accident or illness and act in my stead in approving necessary medical care. Further I authorize any medical provider and/or medical facility to release information of any kind regarding my child to the camp directors: Melissa Case, Debbie Graham, camp nurses, and Stake YW Presidency, Julie Marchant, Kathy Solaegui, Robin Sommers. This authorization is inclusive of the dates of the camp. This authorization shall expire upon return home from this activity or when medical treatment is no longer required, whichever is later. This authorization may be revoked earlier, orally or in writing per HIPAA regulations.

     

     

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  • Emergency Medical Contact information:

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  • Please note all medications will be turned into and dispensed by the camp nurse. If your child suffers from severe allergic reactions and carries an Epi-pen please so note. Also if your child has severe asthma and needs an inhaler at all times please so note.

  • Should be Empty: