Authorization to Consent to Transport & Treatment of Minor:
(I)(We), the undersigned, parent(s)/guardian(s) of the registrant , a minor, do hereby consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any licensed physician and surgeon. It is understood that this authorization is given in advance of any specific diagnosis or hospital care being required, but it is given to provide authority and power on the part of the Heartland Bible Methodist Youth Camp’s staff to give specific consent to any and all such diagnosis, treatment or hospital care which the physician in the exercise of his/her best judgment may deem advisable. We also give permission for the nurse volunteers on the First Aid Team to dispense common Over the Counter medications as applicable, if requested by the camper (unless otherwise notified, in writing, by the parent/guardian).
The signature below must be by the parent/legal guardian unless the camper is 18 years old or above.


Reg Fox by Webconnex
Secure Online Registration Powered by RegFox