Camp Outlaw
643 W Sedgwick St
Philadelphia, PA 19119
Summer 2003
medical responsibility
camper name ___________________________________
parent name(s)___________________________________
phone number____________________________________
pertinent medical history____________________________
______________________________________________
medical insurance_________________________________
______________________________________________
medical release
I release the Camp Outlaw or any staff of Camp Outlaw
from responsibility for any accident or medical difficulty
which may occur while my child is under their care.
parent signature____________________________
date_____________________________________