Medical History

Medical History and consent for treatment. Simply put NA if it does not apply.

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Medical Form

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Feel free to email the secretary to discuss lengthy medication regimens or conditions that take more explanantion at jacobhedrick2@gmail.com .

In the event of an emergency or non-emergency situation

requiring medical treatment, I, the above listed parent /

guardian, hereby grant permission for any and all medical and /

or dental attention to be administered to my child in the event of

any injury or illness, until such time as I can be contacted. This

permission includes, but is not limited to, the administration of

first aid, the use of an ambulance, and the administration of

anesthesia and / or surgery, under the recommendation of

qualified medical personnel.

I acknowledge that the use of over-the-counter medications will

only be dispensed under the supervision of a Registered Nurse

(RN) or Licensed Practical Nurse (LPN) and will only be used

for the intended purpose of avoiding emergency room expenses

to the parent or legal guardian.

I release and waive any claim I may have against the NC

District UPCI, the Sunday School Department, or the individual

members, agents, employees and representatives of either

entity, as well as trip supervisors and drivers for any losses,

damages, or injuries arising out of, during, or in connection with

the participation of the camper named herein in the 2017 NC

District Jr. Camp or the rendering of any emergency medical

procedures or treatment.

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Medical Consent.

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