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Medical Release

My son,

has permission to attend Camp

Wynncliff in Cleveland, Wisconsin.  In the event of a medical emergency, I further give consent to the administration of first aid, his transfer to a medical facility and the administration of treatment deemed necessary by such facility. I understand that every reasonable effort will be made to contact me in the event of an emergency at the following telephone number(s):

phone 1:

name 1:

phone 2:

name 2:

I hereby release the staff of Camp Wynncliff and Wynncliff, Inc. from liability for actions that may be taken as a result of this authorization.


Parent name:

Insurance Company:

Policy number:

Please list any medical conditions you would like to make us aware of that are not listed on the Camper Health History Record:

submission successful!

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