Emergency Medical Authorization:
In the event of a non-life- threatening emergency, if reasonable attempts to contact me or the emergency contacts at the above listed phone numbers have been unsuccessful, I hereby give GSNENY staff my consent to transport my child to an accessible hospital facility, and for administration of emergency medical treatment by any licensed physician, midlevel provider under physician direction, or dentist to order x-rays, routine tests, secure proper treatment for, order injection, anesthesia, or surgery for my child. I understand I am responsible for the cost of medical care. To my knowledge, the health form is correct, and my child has permission to engage in all camp activities except as noted by me and or her physician. I give permission to photocopy this form for out of camp trips and I understand the information on this form will be shared on a need to know basis with camp staff.