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Ozark Nights
Fellowship Baptist Youth Retreat 2017
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Medical Agreement
The person described on this card has my permission to engage in all of the camp activities at the camp named herein and on the dates listed. If a medical emergency should arise while my child is at camp and I cannot be contacted, I hereby give my permission to the camp director to select a physician and/or hospital for my child's care. I hereby also give the physician and/or hospital, as selected by the camp director, my permission to hospitalize, treat and to order injections, anesthesia, or surgery for my child who is named herein. I will also assume the financial responsibility of such treatment as deemed medically necessary by the hospital physicians.
Insurance Company (if none, please indicate as n/a)
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Insurance policy number (if none, please indicate as n/a)
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Medication (if any) Dose/Time
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Allergies or Dietary Restrictions: N/A, if not applicable.
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Emergency Contact
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