This health history is correct as far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted by me on this application. I hereby give permission to the physician selected by the camp director and/or the medical staff to order x-rays, routine tests, and treatment for the health of my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp directors or medical staff to hospitalize, secure proper treatment for, and arrange any surgery for my child as named on this form. I also grant permission for the camp or designated medical facility to contact the camper’s family physician or dentist for information. Please inform your physician and dentist that you have signed this authorization.
By completing this application I hereby authorize Camp Agudah to take my child(ren) off camp grounds, to go on trips organized as part of the camping program. This may include swimming and/or boating activities. In addition my child(ren) may participate in any on or off ground activity organized by camp, including but not limited to land sports, aquatic activities, all boating activities including but not limited to motor boats and water skiing, ropes course, indoor activities, bicycling, hiking, cookouts etc. and I assume the inherent risk of
such activities and camp programs. I will hold Camp Agudah and their staff, harmless in the event of injury or death or property damage or loss as a result of such activities. I also agree to abide by all the rules and
regulations set forth in the application, parents guide and administration.