In the event that an emergency should arise and the Deaf Youth Camp staff cannot contact me or the phone numbers on the pick-up authorization at once, I hereby give my consent to the physician(s) selected by the Camp Director or Camp Nurse to hospitalize, secure proper treatment for, and to order injections, any type of anesthesia or surgery for my child as named below; and relieve the hospital, it's staff and the Deaf Youth Camp and Jackson's Mill, Camp Counselors and volunteers from any liability in connection with medical administration except as covered by Camper Insurance.

In the event hospitalization is required, take my child to the nearest hospital.

Permission is hereby given Deaf Youth Camp to take photographs or video or movie shots of my child to be used by the Deaf Youth Camp for promotional, educational, or fund-raising purposes.

We, the camp staff, reserve the right to use our best judgement in dealing with any problems that may arise at camp.  This may include calling you for additional information, and in extreme cases, a child may be dismissed from camp.

(Note: Both parents should sign, if possible.)

Fathers Signature ______________________________________________

Mothers Signature ______________________________________________

Guardian's Signature ____________________________________________