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Summer Camp Activity Permission

Please review each activity below and mark whether you agree or do not agree for the student to participate. If you do not agree, the student will observe.


Activity 1

Ambulance / Backboard / Stretcher Training

I agree
I don’t agree


Activity 2

Birthing Simulation

I agree
I don’t agree


Parent / Guardian Acknowledgment

By signing below, I acknowledge I have read the above and I authorize the selections indicated.

Name

Signature

Date

Return instructions: Print this page and return the signed form to camp staff.

Broken Aria Reference
Permission for Activities in Ambulance and Birthing Simulation