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.
Date:
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:
