YLC Logo

2022 YLC Camper Medical Release & Consent Form

  • Deadline: May 1, 2022
  • We, as the parents/guardians and camper, understand that every effort will be made by the NAD Youth Leadership Camp officials to reach the authorized persons (e.g., parents or guardians) in case of emergency or when outside medical care is needed. In the event that these authorized persons (e.g., parents or guardians) cannot be reached in an emergency, we hereby give permission to authorize NAD Youth Leadership Camp officials to consent to any medical procedure including but not limited to: X-rays, routine tests, and any other treatment as may be deemed necessary for me named below.
  • We give permission to the physician selected by camp officials to hospitalize, secure proper treatment for, order injections and/or anesthesia, and/or arrange for surgery for the camper as named on the above line.

    We give permission for camp officials to administer medications as deemed necessary to the above named camper. This includes medications sent with the camper, or non-prescription medications available at the camp or prescriptions ordered by a physician during camp session. We understand that any medical expenses will be billed directly to our insurance carrier. The hospital and/or medical facility will be instructed to forward the bill to us if our insurance carrier does not follow through with the payment after a period of time.

    Further, we release the National Association of the Deaf and its officers, directors, employees, agents, and subcontractors, from any and all liability for bodily injury, or cost of medical treatment thereof, or injury incurred as a result of the administration of emergency treatment. This form may be photocopied for use outside of the camp, for the purposes described herein. The camp will charge me for any prescriptions and/or medications ordered by the physician that we do not stock. This includes dental-related concerns. The authorization and consent shall be valid from June 29 - July 24, 2022.
  • MM slash DD slash YYYY
  • Primary Emergency Notification
  • Alternate Emergency Notification
  • Health Insurance Information Note: all campers are required to have health insurance.
  • Max. file size: 300 MB.
  • Max. file size: 300 MB.
  • Max. file size: 300 MB.
  • Important: The camper’s doctor must complete the Health Form. Be sure that the exam is done between July 25, 2021 and June 1, 2022. Exams done before July 25, 2021 will not be accepted. All medications brought to camp by a camper must be in containers that are clearly labeled with the name of camper, the name of medication, the dosage, the frequency of administration and the route of administration. All medication prescribed by a physician must, in addition, be labeled with the name of prescribing physician, the prescription number, date prescribed, possible adverse reactions, the specific condition when contact should be made with the physician and other special instructions as needed.
  • COVID-19 Vaccination

    To safeguard the health and safety of everyone in our camp program, we are requiring all campers to be fully vaccinated against the COVID-19 virus. Please contact [email protected] if you are unable to get vaccinated.
  • Please attach a photocopy of your COVID-19 vaccination. If you do not have it available, please email [email protected] a photocopy of your vaccination card once you've received your vaccination.
    Max. file size: 300 MB.