Emergency Authorization Form
Please print this form and bring it to registration on the first day of camp.
Note that if this form is not completed and signed by a parent or guardian the camper my not be permitted to stay at camp.

Camper Name _________________________________ Camp Session  ______________________

Parent/ Guardian Name _____________________________________________________________

Emergency Contact  ______________________________________Phone (_____)_____-________

Any Activity/ Diet Restrictions  ________________________________________________________

________________________________________________________________________________________________________________

Allergies _________________________________________________________________________

Reactions ________________________________________________________________________

Current Medications ________________________________________________________________

_________________________________________________________________________________________

  • Medications must be in the original bottle. Perscription medication must have the pharmacy label stating person's name and dose ordered by a physician. All medications will be turned in during check-in.
  • I understand that I must give permission before my child receives any over-the-counter medications.
  • My child has permission to participate in all activities on or off the grounds.
  • I give permission for Shiloh Bible Camp to use any photo or video of my family in publications. I release my right to any kind of remuneration for said photos or videos.
  • In case of a medical of a medical emergency for my child, I authorize Shiloh Bible Camp Staff to act in their best judgment to seek medical attention through appropriate means, including ambulance transport and emergency room treatment. I also accept responsibility for expenses incurred through such treatments.

Parent/ Guardian Signature ________________________________Date _______________