Medical Waiver

  • ONTARIO HEALTH MINISTRY REGULATIONS REQUIRE THAT THE FOLLOWING AUTHORIZATIONS BE COMPLETED AND SIGNED PRIOR TO ATTENDING CAMP.

    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.

    AUTHORIZATION TO CONSENT TO TREATMENT OF A MINOR TEMPORARILY SEPARATED FROM HIS/HER PARENTS

  • a minor, do hereby authorize Camp Agudah and/or Rabbi M. Blaustein director of the camp and/or medical staff, as our agent(s) to consent to any diagnostic procedure or medical care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed physician/nurse and/or surgeon at such licensed medical facility chosen by the camp, when such diagnoses or treatment is rendered at said medical facility. It is understood that the authorization is given in advance of any specified need for treatment, and is given to provide authority on the part of our aforesaid agent(s) to give specific consent to any and all such diagnoses, treatments, or hospital care which the physician in the exercise of his best judgment may deem advisable. This authorization shall remain in effect from June 24 - August 12, 2018 inclusive, the aforementioned camper’s session at Camp Agudah.

  • Parent's Waiver

    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.

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