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Medical Release Form ~I _______________________the undersigned, parent of ______________________ give those in charge at Morning Star Camp the permission to obtain any and all medical care necessary for my son/daughter __________________ during their stay at Morning Star Camp from _________ ____ to _________ ____ 2007. ~Known allergies/medical conditions __________________________________________________________ _________________________________________________________________________________________ ~Current Medications ______________________________________________________________________ ~Emergency contact information contact 1~ name ___________________ phone __________________ location ____________________ contact 2~ name ___________________ phone __________________ location ____________________ ~Insurance Information company __________________________________ policy number ______________________________ phone _____________________________________ ~Signed ________________________________________ Date ________________ _____ 200__ »back |