Minor Medical Release Form Page 3
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4Please Furnish the name of school camper attends:
Minor camper attends ________________________________________________________and is
current on all required immunizations.
_____My child is not enrolled in a school system. If not enrolled in school, please attach a copy of
current immunization record to this form.
The following are typical activities at Camp of the Hills. Please check any activity that your child cannot
participate in for medical reasons, and please provide an explanation.
Activity
My child may not participate in this activity because:
Hiking
Water Activities
Ropes Course
Competitive Sports
Strenuous Activity
Parental Authorization
To the best of my knowledge, all information provided about the named person is correct,
accurate, and complete. Permission is granted to participate in camp activities, including the Ropes
Course, except as indicated. Permission is granted for Camp of the Hills to photograph my child and use
these photograph, slideshows, promotional items, etc. in order to promote Camp of the Hills and the
program they facilitate.
Permission is granted for Camp personnel to administer common, non-emergency first aid and medical
treatment, along with over the counter medications kept in stock in the infirmary.
Realizing the nature of serious emergencies, and understanding that I may not be able to be reached at
such times (although every effort will be made to do so) I give my permission that medical measure may
be instituted without delay as dictated by the judgment of the physician selected by Camp of the Hills.
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