Get Leave Application For Ncc Camp

NCC SUMMER DAY CAMP FIELD TRIP CONSENT FORM AND RELEASE I hereby authorize my child to attend the weekly filed trips with NCC Summer Day Camp. I understand that the trips will be off site and may require my child to walk within the camp s neighborhood or other forms of transportation. By signing below I understand that I am waiving any claim I may have against NCC its affiliates agents employees or representatives and release same from any liability for any damages or injuries my child may sustain while participating on the trip. I understand that I am liable for any expenses incurred for injuries that are not covered by my insurance policy. Name of Parent/Guardian PLEASE PRINT Signature of Parent/Guardian Please be aware that no nurse will be present on any of the field trips. If your son/daughter takes any prescription medication on a daily or emergency basis oral inhaler injectable topical please complete the following information and designate the option you prefer OPTION 1 I will accompany my child on the field trip at my own expense and will administer the required medication* I will call my child s physician and obtain written permission to withhold the dose s of to accommodate the field trip s schedule. Attach note from doctor I will provide or have already provided to the Director of the NCC Summer Camp written permission from my child s physician allowing him/her to self administer an inhaler Epi Pen or if needed* I understand that the medication must be provided by my child and will be appropriately labeled by the pharmacy. In the event that I am unable to be reached and my child in your opinion requires EMERGENCY MEDICALTREATMENT during the time he/she is on this camp sponsored trip I grant you permission to obtain any necessary transportation and medical care until I can be contacted* I hereby designate the Director in charge as my agent to act in my child s best interests and release you from any claim arising out of the doctor s actions. I also agree to pay for any professional medical services incurred which are not fully covered by insurance. Name of Parent/Guardian PLEASE PRINT Signature of Parent/Guardian Please be aware that no nurse will be present on any of the field trips. If your son/daughter takes any prescription medication on a daily or emergency basis oral inhaler injectable topical please complete the following information and designate the option you prefer OPTION 1 I will accompany my child on the field trip at my own expense and will administer the required medication* I will call my child s physician and obtain written permission to withhold the dose s of to accommodate the field trip s schedule. If your son/daughter takes any prescription medication on a daily or emergency basis oral inhaler injectable topical please complete the following information and designate the option you prefer OPTION 1 I will accompany my child on the field trip at my own expense and will administer the required medication* I will call my child s physician and obtain written permission to withhold the dose s of to accommodate the field trip s schedule. Attach note from doctor I will provide or have already provided to the Director of the NCC Summer Camp written permission from my child s physician allowing him/her to self administer an inhaler Epi Pen or if needed* I understand that the medication must be provided by my child and will be appropriately labeled by the pharmacy.