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. I give permission to nurse to provide relative treatment related to the health of my child for both routine health care, including administering medications and in emergency situations. If I cannot be reached in an emergency, I give my permission to the call appropriate emergency personnel and secure proper treatment for this child. I understand the information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form for nursing records. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.