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This agreement includes 1. Medical treatment and disclosure authorization 2. Assumption of Risk acknowledgment 3. Liability release 4. Publicity release 5. Medical Fitness

If my child is accepted to camp, I hereby authorize the Camp Director(s) of Camp Jamison or such designee(s) as the Camp Director(s) may appoint, to provide for the giving of emergency medical care or treatment, including medicines, immunizations, x-rays, tests, dental and minor surgical treatment, hospitalization, general anesthesia, or other medical treatment as may be appropriate while the child is in the care of Camp Jamison. Notification of the parent or guardian will always be attempted.

I authorize any physician, nurse or other health care provider, to communicate with the medical staff and director of Camp Jamison, or his/her designee, about my child’s medical condition, treatment, and/or prognosis. I further authorize the camp medical staff to discuss any medical conditions with the director, his/her designee, or the child's counselor when the medical staff, in its sole discretion, believes such communication to be in the best interest of the child. These authorizations are limited to the dates of camp for which my child is registered. I hereby agree for him/her to attend the functions provided by Camp Jamison during the dates for which my child is registered. To the fullest extent allowed under law,

I hereby release Camp Jamison and its personnel and volunteers from any and all liabilities to my child as a result of mode of travel to and from the aforementioned camp; engagement of activities during camp; use of materials, buildings and/or environment; loss or destruction of personal property; and specifically, give permission for my/our child to attend this function. I understand that part of the camping experience involves activities and group interactions that may be new to my child, and that they come with uncertainties beyond what my child may be used to dealing with at home. Such risks include uneven terrain, standing and moving water, wildlife encounters including mammals, reptiles and insects. I am also aware that my child may participate in off-campus activities such as swimming trips that involve additional risks. In addition, there are certain unavoidable risks associated with various game and play activities such as collisions, wayward objects such as balls and other equipment and other risks. I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by the camp’s rules, and my child and I both agree that he or she is familiar with these rules and will obey them. I give my consent and permission for Camp Jamison to use or authorize the use of any photos, video, interviews, or other publicity-related items involving my child. (If, for any reason, you do not want photos or videos of your child used in publicity-related items, please contact Camp Jamison in writing.)

This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician.