Summer Camp 2023 Consent Form "*" indicates required fields Parent's/Legal Guardian's Name* First Name Last Name Email Address* Purchase Order ID* Child's Name* First Name Last Name * I, parent or legal guardian of the child listed above, give consent for my child to attend Star Academy’s Summer Program. Emergency Medical Consent* I hereby authorize the Star Academy for the Gifted and Talented, Inc. (henceforth referred to as STAR ACADEMY) staff or other appropriate personnel to provide first aid, emergency medical care, or if necessary, admission to an accredited hospital, when such care is necessary for the treatment of any injuries, allergic reactions or illness my child may sustain while participating in any activity associated with STAR ACADEMY I have provided my emergency contact(s) as part of my program registration. Sunscreen/Insect Repellent Consent* I hereby authorize the STAR ACADEMY staff or other appropriate personnel to apply the sunscreen (with sun protection factor of 25 or more) and insect repellent that I have furnished, when needed, while participating in any outdoor activity associated with STAR ACADEMY. In the event that I have not furnished sunscreen/insect repellent or it is otherwise unusable, the use of STAR ACADEMY’s sunscreen and insect repellent is acceptable, and both are able to be applied as a spray. I do not authorize STAR ACADEMY staff or other personnel to apply sunscreen or insect repellent, which I furnished or STAR ACADEMY provided, understanding that it is my responsibility to ensure my child is furnished with appropriate sun and insect protection prior to arriving at the program. Emergency Epinephrine Use*In the event that my child has allergies, I will provide the appropriate medications and documentations, possibly including an emergency epinephrine dispenser. I, parent or legal guardian of the child named above, give consent for any trained adult along with the trained Health Care Supervisor to dispense emergency prescribed epinephrine to my child in the event of an allergic reaction. I hereby give consent for a trained adult to dispense epinephrine in the event of an allergic emergency. I do not give consent for any adult beyond the trained Health Care Supervisor to administer epinephrine. My child does not have allergies requiring epinephrine. Consent of Antihistamine Use*I, parent or legal guardian of the child listed above, understand that my child’s participation in STAR ACADEMY’s Summer Program will include various outdoor and indoor activities. As such, I acknowledge that it is possible that my child(ren) may encounter various insects/plants that may cause an anaphylactic reaction that is previously undiagnosed. I give consent for the trained Health Care Supervisor to dispense camp provided antihistamines in the event that my child experiences mild symptoms of an allergy. I hereby give consent for a trained Health Care Supervisor to administer antihistamines in the event of an allergy. I do not give consent for my child to be given any antihistamines in the event of an allergy. Consent for Use of Hand Sanitizer*As a parent/guardian I understand that my child’s participation will include various outdoor and indoor activities with participants from various households. As such, I acknowledge that in order to maintain my child’s health and safety, frequent hand washing is necessary. Please select if you authorize the use of 60% alcohol-based on your child while under the supervision of STAR ACADEMY’s staff. I hereby authorize the STAR ACADEMY ‘s staff or other appropriate personnel to supply 60% alcohol based hand sanitizer when hand washing is not available, while participating in any outdoor activity associated with STAR ACADEMY’s Summer Programs. I do not authorize STAR ACADEMY ‘s staff or other personnel to supply a 60% alcohol based hand sanitizer, which STAR ACADEMY provided.
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