CAMP O’MALLEY MEDICAL CONSENT FORM
Name of Camper: _______________________________________________________
I, as legal guardian of the above named camper, authorize the coaching staff and /or
designee of Forest Hills Central High School Football program to seek medical treatment
for my son as they see necessary at any nearby medical facility. I consent to any
treatment and hospital care deemed necessary by a licensed health care provider during
the camp session.
I understand that this authorization is given in advance of any specific diagnosis,
treatment or hospital care, and that it is given to provide the camp coaching staff
authority to seek medical treatment, and to provide a licensed health care provider the
authority to administer this treatment as deemed necessary to the above named child.
I accept responsibility for payment of all services rendered; I authorize any medical
facility rendering services to release medical information necessary for the processing of
insurance claims; and I authorize the payment of insurance claims directly to the medical
I understand that whenever possible, the Ranger Football Program staff will make a good
faith effort to contact me or an emergency contact person(s) before seeking treatment. If
this is not possible, I understand that the Program staff will notify me or my designee as
soon as possible of any and all diagnoses and treatments.
(Signature of Consenting Parent/Guardian
Medical Consent is required before departure to Camp O’Malley. Please return this
printed form to Coach Rogers or send in by mail to:
Attn: Camp Registrar
P.O. Box 763