SM | Parent Release & Medical Information Form (2025)

To be completed by a parent or legal guardian of any student attending a New Heights Church camp or activity.

Please submit a separate form for each student. 

EMERGENCY CONTACT

In case we are unable to reach you in an emergency:

STUDENT INFORMATION

Date

MEDICAL INFORMATION

We care deeply about your student’s health and safety. A registered nurse, physician's assistant, or medical doctor will be present at overnight camps and will oversee the care and dispensing of all medications.
Date

Over-the-Counter Medication

The following over-the-counter medications are available through the nurses at camp, and there is no need to bring the following medicines to camp:

Acetaminophen (Tylenol), Antibiotic Pintment/Cteam, Benzocaine 20% (Orasol/Oragel), Burn Gel/Spray, BZK Wipes (Antiseptic Wipes), Calamine Lotion (Zinc Oxide and Iron Oxide), Cepacol Throat Lozenges/Spray, Cetirizine (Zyrtec), Chlorpheniramine (Chlor-Trimeton), Cough Drops, Cough Syrup (Dextromethorphan/Guaifenesin) (Robitussin DM), Diphenhydramine (Benadryl), Docusate Sodium (Stool Softener), Eye Drops, Hydrocortisone Cream, Hydrogen Peroxide, Ibuprofen (Advil/Motrin), Loratadine (Claritin), Pectin Lozenge, Phenylephrine (Sudafed PE), Simethicone (Gas-X), Swim Ear, Tecnu Soap, Tums.

Student Ministries Behavior Expectations

To ensure a safe, respectful, and fun camp experience for everyone, all students are expected to follow these guidelines:
• Follow the direction of adult leaders and staff
• Treat others with respect in words, actions, and attitude
• Respect property—don’t damage or take what isn’t yours
• Speak positively—no gossip, bullying, or put-downs
• No drugs, alcohol, tobacco, vape pens, or similar items
• No weapons, pocket knives, or unsafe items
• Do not enter sleeping areas of the opposite gender
• Cell phones are not allowed at summer camp

Failure to follow these expectations may result in your student being sent home. If that occurs, families are responsible for transportation and no refund will be issued.

I have read the above expectations of student behavior, I agree with them and will, if deemed necessary by the leadership, pick up my son or daughter from an activity.

I also understand that if my son or daughter is sent home form camp due to a violation of these standards, no refund for the activity will be issued.

I, the undersigned, am the parent or legal guardian of the student named above. I give permission for my student to participate in New Heights Church activities, including off-site events and transportation provided by the church.

In the event of an emergency, I authorize New Heights Church staff or volunteers to secure medical treatment for my student from licensed medical professionals. I accept full financial responsibility for any care provided.

This authorization remains valid for one year from the date below, or until revoked in writing.

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