Does the camper have : (select all that applies)
Has the applicant had:(circle answer)
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Please list ALL prescription drugs being brought by the camper:
NOTE: All medications must be in their original containers, must be in a labeled zip lock bag, and must be turned into the Camp Good News nurse at registration. No medication of any kind will be allowed in the cabin without the knowledge and approval of the Camp Good News Director AND Nurse.
I, ,parent/guardian of
hereby authorize the nurse on duty at Camp Good News to serve on loco parentis for me in giving the following over-the-counter medication to my son or daughter: Tylenol (acetaminophen) or Advil (Ibuprofen) for pain, Tums (antacid) for upset stomach, or other over-the-counter medications that i have supplied for my son or daughter. I authorize the Camp Director, the Child Evangelism fellowship (CEF) State Director , and the nurse on duty to serve in loco parentis for me in talking my son or daughter to a doctor or emergency room for any urgent need with the understanding that the i will be notified as soon as possible.
LIABILITY AND RESPONSIBILITY CLAUSE
Child Evangelism Fellowship is not responsible for any medical bills incurred while my child serves as camp counselor at Camp Good News. I agree to use my own medical insurance as a primary coverage in the event that my child needs medical care. I understand that i, the parent or guardian, will be responsible for any medical bills for mu child and will make sure all medical bills are paid for in full.
Please make a copy of both sides of camper's insurance card and include with this form.