2017 Summer Under the Trees – Medical Info, Permission and Release

2017 Summer Under the Trees – Medical Info, Permission and Release

This form is for campers enrolled to attend any week of Summer Under the Trees. We collect this information to keep our campers safe and healthy; please be sure to complete it as accurately as possible. This form needs to be completed before the first day your child attends camp!

 

2017 Summer Under the Trees - Medical, Permission and Release

  • Please enter any allergies your child has. If none, NA.
  • Please list any special medical needs your child has. Enter NA if none.
  • Please list any medications your child takes on a regular basis. If medicine is to be administered during camp, parents are required to 1) bring medication to the office in its original container(s) and 2) complete a "Permission to Administer Medication" for each medication.
  • Please list any professional evaluations your child has undergone.
  • I hereby grant permission for Summer Under the Trees staff to reapply or help my child reapply sunscreen brought from home if necessary.
  • I hereby grant permission for Summer Under the Trees staff to reapply or help my child reapply bug repellent brought from home if necessary.
  • Doctor's Name
  • Doctor's Phone Number
  • A child's parents are the primary emergency contacts. In addition to the parents, please list other adults (NAME AND PHONE) to contact in the event that you cannot be reached. Emergency contacts need to be local contacts so they are available to respond.
  • I hereby grant permission for the Head of School or authorized school personnel to take any steps necessary to obtain emergency medical care for my child if warranted. These steps may include but are not limited to attempting to contact a parent, guardian, the child's physician or any of the persons listed on the emergency information provided to the school by the parent or guardian. If the above mentioned cannot be contacted, school personnel may do any or all of the following:call another physician, call an ambulance, have the child taken to an emergency hospital in the company of a staff member. Any expense incurred while enlisting the help of a medical personnel as listed above will be borne by the child's family.
  • I hereby grant permission for the name and/or likeness of my child to be included in:marketing initiatives of the school. Internal and external marketing initiatives may include but are not limited to promotional literature published by Chance School, articles and/or photographs to be published in area newspapers, photographs and video featured on the Chance School website and on Chance School social media sites, and filmed segments to be aired on local television stations. Materials may also include required videotaping for internship or other university coursework. Students' names may or may no be published in such documentation.