Care Information
We desire to give every child an excellent experience. This care plan will help our team serve your child best. Complete all sections that apply.
Please select any behavioral difficulties that apply to your child, and rate the frequency in which the behaviors occur: (1 = Occurs rarely; 5 = Occurs often)
We look forward to partnering with you to provide the best care for your child! A campus representative will connect with you soon!
5/8/2026 5:12 AM
Medical Authorization and Emergency Treatment Consent
I, the parent or legal guardian of the above-named participant, authorize the staff, volunteers, and designated medical personnel of the church/camp to administer routine first aid and necessary medications as outlined in the participant’s health information and care plan.
In the event of a medical emergency, I grant permission for the program staff to administer emergency care, including the use of emergency medications such as epinephrine for severe allergic reactions, and to contact emergency medical services (911) when deemed necessary.
I understand that every reasonable effort will be made to contact me or the emergency contacts listed. However, if I cannot be reached, I authorize the program leaders to secure appropriate medical treatment for my child, including transportation to a medical facility.
I acknowledge that staff members may administer emergency medication when symptoms of a serious allergic reaction or other life-threatening condition are present. I understand that in such situations, emergency medical services will be contacted immediately.
By signing below, I confirm that the medical information provided for my child is accurate to the best of my knowledge and that I give permission for the above actions to be taken in the best interest of my child’s health and safety.
5/8/2026 5:12 AM