Emergency Contacts and Authorized Pick Up Persons: (In addition to parents/guardians)
Use this area to list the individual(s) we may contact in an emergency and/or you authorize to pick up your camper from
PARENTAL CONSENT TO TREATMENT / ACKNOWLEDGEMENT OF RECEIPT OF INFORMATION
I hereby authorize the Skunk Rock Camp Directors to provide routine health care, administer medications as ordered by a physician, obtain emergency medical treatment including radiology and laboratory studies, and arrangement of transportation for same. I agree to the release of any records necessary for medical treatment or insurance purposes. I consent to allow the physician selected by Skunk Rock Directors to secure and administer treatment, including hospitalization for the minor named above.
I understand these risks and release Skunk Rock, and the directors, trustees, officers, volunteers and employees of Skunk Rock Summer Camp from all liability for damages or injuries resulting from summer camp activity, negligence or defects in the preparation, instruction, or equipment.
Skunk Rock is not responsible for lost, stolen, or damaged personal articles.
I authorize Skunk Rock to have and use photographs, slides, videotapes, and comments of the person(s) named on this application as needed in promotional materials and public relations programming.
I individually and corporately agree to hold harmless, Skunk Rock, its volunteers, agents, employees and officers irrespective of any negligent act or omission by Skunk Rock and/or those individuals arising from or related in any way to this Skunk Rock music program.