Pennsylvania Medical Release Form 2
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Medical Release Form
Parent Consent/Physician’s Certificate
Please check all camps attending
❑ Day
❑ Sports
❑ Enrichment

❑ Performing Arts
❑ Science

Varsity: ❑ Baseball ❑ Basketball ❑ Tennis
❑ Youth and Money
Bunk (assigned later by camp) _________

No camper shall be permitted to participate in any activities until this certificate of consent is signed by the camper’s parent or guardian, and until the camper is
examined and pronounced in satisfactory physical condition by his/her own physician.
For Parents/Guardian
We/I consent to full participation in all sports and physical activities by:
Camper____________________________________________________________________________

Age_____________________________

Parent/Guardian Signature_______________________________________________________________

Date_____________________________

(Signature gives permission for the camp nurse to administer prescribed medication as outlined below in the Physician’s Order and/or over-the-co