AUTHORIZATION FOR TREATMENT
This health history is correct to the best of my knowledge, and the person herein named has permission to engage in all camp activities except as noted. I hereby give permission and authorize the medical provider selected by the Camp Director to secure or administer emergency medical treatment, including medical transportation and hospitalization and any other emergency medical procedures and services which may be needed for the person named herein. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, and is given to encourage those persons who have temporary custody of the minor, and said medical provider or dentist to exercise their best judgment as to the requirements of such diagnosis or medical, dental or surgical treatment. In addition, I authorize camper to carry emergency medications and use as directed.

I agree to remain fully liable and responsible for the payment of any such hospital, doctor, medical transportation, dental or medical fees. I further agree that in giving this permission and authorization, Circle of Faith Ministries does not assume any responsibility or liability for the payment of such hospital, doctor, medical transportation, dental or other medical fees which may be incurred. The completed forms may be photocopied and maintained by authorized personnel as needed including trips out of camp.