Khalsa Camp

Parent Health Notice

As per camp licensing agreement with the local Board of Health, Siri Om Fuller is the Health Care Supervisor and Khalsa Camp will post our Health Care Consultant on or before the first day of camp. During camp, Siri Om Fuller and Jai Fuller will care for minor medical injury’s, including cuts, abrasions, bruises, minor headaches, and in the case of more serious injuries, provide treatment until medical attention can arrive or the child can be transported to the nearest medical facility. If your child has had a fever of 100F or higher within the last 24 hours they may not attend camp for that day or until 24 hours after the temperature becomes normal (98.6F). If your child has a cold or cough with colored mucus, any form of ear infection not yet treated, or chicken pox, they may not come to camp unless accompanied by a note signed by their doctor that they are not contagious. We reserve the right to call you at any time and have you pick your child up immediately if we feel that your child should see a medical professional or may have a contagious illness the other children may contract.

Siri Om Fuller is a Wilderness First Responder, with CPR (for the professional rescuer,) Oxygen, Basic Life Support training, and training in anaphylaxis reactions. Jai Fuller is certified in CPR and First Aid. If an injury or accident occurs in which we are not able to treat within our medical abilities, we will transport your child to a medical facility for necessary treatment.

Plan for Mildly Ill Campers

If participation in any of the camp activities for the day, (hiking, swimming, athletics etc.) is not deemed appropriate for the camper by the child, staff, or parents, the child should not attend camp that day. If child falls ill after being dropped off for the day, we will contact the parent/guardian to come and pick up the child. During this time we will provide a comfortable space for the child to rest and give care accordingly until parents arrive.

Health Care Consultant

To Be Announced on or before June 26, 2017

Health Care Supervisor

Siri Om Fuller

Cell: (413) 374-9388

Jai Fuller

Cell: (413) 658-8834

Mt. Toby Meetinghouse (camp base)

(413) 548-9188 only call during camp hours (8:45-5:00 M-F)

Khalsa Camp

Emergency Authorization and Waiver

IMPORTANT:

This form must be filled in completely by placing your initials by each box and signing below before your child may attend camp.

EMERGENCY AUTHORIZATION

In the event that neither myself nor the emergency contact can be reached, I hereby give permission to Khalsa Camp, Jai Fuller, Siri Om Fuller, and any of their chosen employees to provide medical treatment for my child ______, including, but not limited to cleaning cuts and abrasions, providing ice or over the counter medications, rescue breathing and CPR.

Furthermore, I give permission for Khalsa Camp, Jai Fuller, Siri Om Fuller, and any of their chosen employees to transport my child to the nearest medical facility when the need for medical attention requires a doctor or task above and beyond which we can provide.

I understand that the attempt will be made to contact me in the event of a medical emergency and that I am responsible for all medical cost incurred in treating my child, including transportation to or from a medical facility.

WAIVER AND RELEASE

I, ______, wish to enroll my child in the programs and activities at Khalsa Camp, in Massachusetts.

I am aware that there are a variety of activities on a daily basis in which my child will be participating and I recognize that some of these activities involve physical risk, including the risk of serious injury or death.

I hereby agree to assume all of the risks in connection with my child’s attendance, including travel and transportation, except in the case of negligence or willful misconduct. I will not hold Khalsa Camp, Jai Fuller, Siri Om Fuller, and any of their chosen employees liable for any inherent risks involved in this program.

I agree that the laws of the Commonwealth of Massachusetts shall govern this waiver and release.

I affirm that I have carefully read and understand this document.

The health history on my child’s medical form is correct, so far as I know, and the person herein described has permission to engage in all prescribed activities except as noted.

Child’s Name: Parent Name:

Signature of Parent: Date: