Medical Form.
Carolina Cross Connection (CCC) is a Christian organization that creates mission experiences for students and adults.
In the event that I, or my/our child, is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment deemed necessary by a licensed physician. I/We give permission to the CCC Camp Director and/or our church group leader to select a physician, to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for me/my child as deemed necessary by a licensed physician.
In the event of a medical emergency, if the participant is under the age of 18, I/we understand every reasonable effort will be made to contact me/us, or the emergency contact or the emergency contact I/we have designated on this form, en route to or upon arrival at the hospital or health care facility.
In the event treatment is required from a physician and/or personnel designated by CCC, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that I/we will be ultimately responsible for the cost of any medical care, should the cost of that medical care not be reimbursed by the primary health insurance provider (my/our family’s) and/or the secondary health insurance provider (those of CCC and the camp).
I/we affirm that the health insurance information on this form is accurate at this date and will, to the best of my/our knowledge, still be in force for the participant.
I/we agree to go home or bring my/our child home, at my own/our expense should I/they become ill, if I/they fail to comply with the Code of Conduct below, or if otherwise deemed necessary by the CCC summer staff. If the participant is under the age of 18, I/we understand that all medical and behavioral issues will be discussed with the Camp Director and an adult from my/our church, if possible of the same gender.
MEDIA RELEASE & WAIVER:
I/we give permission for images of myself/my child, through photographs, video, or other likenesses, to be used by CCC for the purpose of promotional materials. I further release CCC from any liability associated with the promotional use of these images. I/we release any claim to said images, and acknowledge that they are the sole property of and are copyrighted by CCC.