Medical Information and Release

By executing this Medical Information and Medical Release Form, I also affirm that the medical/health history which I have provided for my child/ward is true and accurate, and that my child/ward set forth above has my permission to engage in all Program activities unless specifically noted by me in writing to the contrary on this enrollment form.  If medically necessary, I hereby give permission to a physician selected by the Laffalot Summer Camp, LLC ["Laffalot"] staff to order necessary x-rays, tests and treatment for the health and benefit of my child/ward.  In the event of a medical emergency, I understand that the Laffalot staff will be contacting emergency medical staff personnel for the treatment of my child/ward and possible transport to a local hospital.  In the event I cannot be reached, I hereby give permission to the physician selected by the Laffalot staff to hospitalize, secure proper treatment for and to order any necessary injections and/or surgery for my child set forth above.