CONSENT FOR EMERGENCY MEDICAL TREATMENT

As the Parent or Authorized Representative, I hereby give consent to Rescue Rangers Day Camp to obtain all emergency medical or dental care prescribed by a duly licensed physician (M.D.) osteopath (D.O.) or dentist (D.D.S.) for                                                                                (Child’s Name). This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of the child named above.

CHILD HAS THE FOLLOWING MEDICATION ALLERGIES:

            Date                                                Parent or Authorized Representative Signature

Home address:                                                                                                                              

Home Phone:                                                     Work/Cell Phone: