This form will be copied.

Complete parent/guardian info if participant is a minor.

We will work to meet any medical dietary restrictions but cannot guarantee to honor individual food perferences. Please call if you have questions regarding diet.

Bring enough medication to last the entire session. ALL medication MUST be appropriately labeled.

Provide additional information about your/participant's health which may have been neglected on this form, or additional information of which our pastors or outfitters should be aware.

In the event something unforseen occurs, who would you like us to notify in an emergency?

In the event of an accident that requires medical attention it may be helpful for us to have insurance information to pass onto the treating hospital or clinic.

For Adult Participants
To the best of my knowledge, the information provided on this form is correct, and I am able to participate in all camp activities (with any above noted exceptions). I understand that my health information will be shared with trip leaders on a "need to know" basis and that, as an adult, I retain primary responsibility for managing my health status while on the trip. I agree to inform CtK of any changes that might impact my participation. In the event that I (or my spouse) cannot make a decision in an emergency, I hereby give my permission to the physician selected by CtK trip leaders to secure proper treatment for, and to order injection, anesthesia, or surgery for myself as named in this form. I understand that my insurance has primary coverage.

For Parents/Guardians of Minor Participants
To the best of my knowledge, the information provided on this form is correct, and my child is able to participate in all camp activities (with any above noted exceptions). I understand that the participant's health information will be shared with trip leaders on a "need to know" basis and that if I, or another parent/guardian, am a participant on the trip, I/they retain primary responsibility for managing my child's health status while on the trip. I agree to inform CtK of any changes that might impact my child's participation. In the event that I (or another parent/guardian) cannot be reached to make a decision in an emergency, I hereby give my permission to the physician selected by CtK trip leaders to secure proper treatment for, and to order injection, anesthesia, or surgery for my child as named in this form. I understand that participant's insurance has primary coverage.