IMPORTANT - This authorization for Health Care MUST be completed by Parent/Guardian
To the best of my knowledge this health form is correct and the person described is in good health. My child has my permission to engage in all camp activities except as noted. In case of emergency, if parents or emergency contact can’t be notified, I hereby give permission to the medical personnel and/or hospital selected by the Camp Director to secure proper treatment for my child as named above; release any records necessary for insurance purposes; and to provide or arrange necessary transportation. I understand the information on this form will be shared on a ‘need to know’ basis with camp staff. This completed form may be photocopied for trips out of camp.
I have disclosed all pertinent medical information including information regarding prescription medications. I hereby give permission to allow my child’s physician to give Camp Chabad medical information about my child, should it be required by the camp.