PARENT GUARDIAN CONSENT:
I declare that I
1. Have legal custody of the herein named child applying to Camp Mishewah.
2. Declare that the herein named child is in good physical and emotional health and amenable to Camp Mishewah authority.
3. Will ensure that the herein named child will leave all electronic devices at home while at Camp Mishewah (Sr. Teen excluded).
4. Am responsible for payment of fees and any other expenses incurred by my herein named child.
5. Declare that the herein named child attending Camp Mishewah is covered by their provincial health plan or equivalent medical insurance.
6. Declare that I have submitted my child’s up-to-date medical information and agree with the following Consent to Treatment statements:
• To the best of my knowledge, my child is in good health. If my child becomes exposed to any serious/infectious diseases within four weeks of attending camp, I will notify the Camp Directors.
• I understand that every effort will be made to contact parents/guardians before any major treatment is administered.
• In case of a surgical emergency where I am not available for consultation, I hereby give permission to the physician selected by the Camp Director or designate to hospitalize, secure proper treatment for and to order injections, anesthesia, or surgery for my child.
• I give permission for the Camp Nurse or trained personnel to administer stock medications that are approved by a physician in case of minor injury, and/or illness during my child’s stay at Mishewah.
• I also give permission for the Camp Nurse or trained personnel to provide Standard First Aid to my child as appropriate.
• I give permission for the Camp Health Nurse or trained personnel to administer medications provided by me as per indicated on the submitted health form.
• I give permission for Epinephrine to be administered to my child in case of an anaphylactic (life-threatening) reaction.
• I agree to indemnify and hold blameless Evergreen Christian Ministries, its staff, its directors and board, and the medical personnel representing the camp from and against any loss, damage, or injury suffered by the camper as a result of being a participant in the normal activities of Camp Mishewah.
• I agree that all the information given on the Camper Health & Medical Form is correct and complete.
• By signing, I agree to pay all health related expenses and treatments not covered by the Provincial Health Plan (ie. lice treatments, medications, dressing supplies, casts, etc.)
7. Give permission to Camp Mishewah to use photographs and video of the herein named child for promotional material.*
8. Give permission for the herein named child to be transported by bus or personal vehicle to offsite locations for hiking, canoeing, and excursions or to be taken to the hospital/clinic for medical treatment if necessary.
9. Give permission for the herein named child to participate at Camp Mishewah, its facilities, programs and activities. All physical programs and activities have risks and I understand there are physical risks and hazards inherent in any program or activity. I am allowing my child to participate and understand that I am exposing my child to inherent risks and hazards. I agree to accept all risks and hazards and be responsible for any injury or other loss which may occur during my child's participation. I understand that reasonable precautions shall be taken to ensure the health and safety of the herein named camper.
* If you do not want photos of your child used, please send an explanation to
[email protected] along with a recent photo of your child. Thank you.
