PARTICIPANTNAME:___
I authorize designated camp staff to administer prescription and/or over-the-counter medications to my child as documented on the Medication Administration Form.
I understand that:
Medications must be provided in original containers
Instructions must be clearly labeled
Medication will be administered by authorized personnel only
□ I GIVE permission
□ I DO NOT GIVE permission
Parent/Guardian Initials: ___
I authorize Kentucky State University staff and representatives to seek and obtain medical care for my child in the event of illness or injury when I cannot be reached.
This includes authorization for:
Emergency medical treatment
Hospitalization
Necessary medical procedures as determined by licensed medical personnel
I understand that I am financially responsible for any medical services provided.
□ I GIVE permission
□ I DO NOT GIVE permission
Parent/Guardian Initials: ___
I understand that Kentucky State University does not provide medical insurance coverage for participants. I agree that:
I am responsible for all medical expenses incurred
I have provided current insurance information (if applicable)
□ I ACKNOWLEDGE AND AGREE
Parent/Guardian Initials: ___