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Parental Consent Form

I acknowledge that there are risks inherent in any children’s program, including but not limited to injury or death arising from: participation in sports; child’s failure to follow instructions of supervisors; communicable illness; and independent acts of third parties not under the control of supervisors. I acknowledge that all risks cannot be prevented, and assume those risks beyond the control of the staff. In order to minimize risks to my child and/or other participants, I will take responsibility to see that my child is prepared for all activities and is in good health each day of the session.

In case of medical emergency, I understand that every reasonable attempt will be made to contact me,my family physician, or the emergency contact named below. However, in the event that I or my named contacts can not be reached, I give my permission to Moe’s Camp and/or its representatives to secure emergency medical treatment for my child. I agree to pay for any charges for emergency medical treatment that are not covered by my personal health insurance.

I hereby give permission to Moe’s Camp to transport the child named below for the purpose of medical care or program activities as deemed appropriate by the Camp Director. In the event I cannot be reached in an emergency, I give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection, anesthetic or surgery for the child named above. I understand that Moe’s Camp does not provide accident/medical insurance for the child named above. Medical bills, including prescription drugs, will be the responsibility of the parent or guardian named below.

I hereby consent to the participation of my child:

Thank you! Consent Form Received

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