I, the undersigned parent/guardian of __________________________________, do hereby consent to any medical treatment necessary as a result of injury or illness. I understand that this consent is given to the ICHA Youth Camp Staff in advance in the case of an emergency and allows the hospital physician to exercise their best judgement.

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Parent Signature

________________________________________

Date

________________________________________

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Permission for camp nurse to give Tylenol to camper, if requested.

Yes_____  No_____

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*You may print this page and bring completed form with parent's signature to registration or sign the release we will have available there.