Volleyball Camp Medical Form
In the event that my dependent is injured or becomes ill, necessitating immediate medical examination or care, while under the supervision or while participating in activities sponsored by the Bermuda Volleyball Association, I authorize and release to any agent of the Bermuda Volleyball Association, to take my dependent to a Bermuda medical facility deemed necessary by the above referenced individual.  

I understand that the personnel of the Bermuda Volleyball Association will use all diligent and reasonable efforts to contact my spouse and or me.  If personnel of the Bermuda Volleyball Association or of the medical facility can contact neither my spouse or me after reasonable attempts, I authorize and release any physician or other qualified medical personnel to examine my child.  I authorize any and all emergency care necessary for treating injuries or illnesses involving immediate danger of life or limb of my dependent.  I further authorize non-emergency care necessary treatment such as suturing superficial lacerations, treating colds, minor allergies and minor gastro-intestinal upsets, splinting sprains, casting uncomplicated fractures, or similar treatments.  
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Campers First Name *
Campers Last Name *
Week of Camp my child is attending: *
Parent First & Last Name *
Parent Phone Number *
My dependent has the following medical problems (such as diabetes, seizures, asthma, heat and kidney disease): *
My dependent is allergic to the following: *
My dependent takes the following medications on a regular basis and/or “as needed” basis (list name, amount and purpose of the medication) *
Please advise if your dependent, or any member of your household, has tested positive for COVID-19.  If so, please confirm the date of diagnosis and recovery.   *
Please advise any travel completed in the 3 weeks prior to the start of camp, by any member of your household.  Confirm that all government guidelines regarding return to work have been complied with.   *
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