Diocese of Victoria Authorization Form

Camper Name(Required)

First Last

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Relationship(Required)

Relationship of the Emergency Contact to the Camper/Registrant

Alternate Emergency Contact(Required)

First Last

Alternate Emergency Contact Phone(Required)

Relationship(Required)

Relationship of the Emergency Contact to the Camper/Registrant

Parent / Guardian Authorization for Health Care

I attest the online health history is correct and accurately reflects the health status of the camper to whom it pertains. The camper described has permission to participate in all camp activities except as noted by me and/or a a licensed prescriber (MD, NP). I give permission to the camp to order tests provide needed care and treatment, and give medications, related to the health of my child for both routine health care and in emergency situations. I give my permission to the camp’s healthcare prescriber to hospitalize, secure proper treatment for, and seek emergent care for my child if needed. 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. In addition, Sonlight 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 camps staff about my child's health status.

Yes

Authorization for Photos(Required)

I give my permission for photos taken of me/my child participating in camp activities may be used for the promotional purposes of camp and Sonlight, to include the website and printed material.

Yes

Authorization for Transportation(Required)

I give permission for my child to ride in a Sonlight Vehicle (vans or school bus).

Yes

Authorization for Sunscreen(Required)

I understand that Sonlight Camp provides SPF30 Broad Spectrum Sunscreen (brand: Rocky Mountain Sunscreen) for campers. If I provide sunscreen for my child it must be labeled with the individual's first and last name.

Yes

Acknowledgement of Risk(Required)

I understand that camp can have certain inherent risks, that the mountain environment is different than the city. Situations may arise which will be handled differently than in an urban area. I understand that cell phones /devices that connect to internet or wireless service may not be used by campers.

Yes

Signature

Name of Parent / Guardian Signing the Form(Required)

First Last

Date