List any allergies, medications, conditions or health concerns our medical officer & staff should be aware of. IF NONE, PLEASE TYPE "N/A"
List any medications you will NOT permit the nurse to administer: IF NONE, PLEASE TYPE "N/A"
Aside from attending church, please list your involvement in your home church and/or outside church community.
I hereby authorize the Katepwa Lake Camp medical officer to provide or secure medical services as may be deemed necessary for my child's health and safety. I will be informed immediately of any medical services that are required. I release Katepwa Lake Camp and anyone connected with it from any and all liability claims resulting from accident and/or misfortune. I agree that my child's image or likeness may be used in camp activities or promotional material eg. cabin skits, calendars, websites, etc. Lastly, I agree that the camper (my child) is physically and mentally able to participate in all camp activities (unless otherwise noted in writing). ***Note: Should this not be acceptable, please contact The Katepwa Lake Camp Director in writing before camp begins.***