Medical Release Form

Medical Release Form

MEDICAL RELEASE INFORMATION: Please complete and submit this form and provide a copy of the State Certificate of Immunization for your child to the Mizel Museum, 400 S. Kearney Street, Denver, CO 80224. Campers will not be admitted without completed medical information. Doctors’ offices may fax the immunization record to Tia at 303-394-1119.
  • Emergency Contact

  • In case of emergency if you can’t be reached, who should be contacted?
  • Persons authorized to pick up your child

    (your child must be signed in and out each day by authorized person)
  • Sunscreen Application

  • I give my permission for the staff at Mizel Museum to assist with applying or to apply sunscreen to my child’s exposed skin including the face, tops of ears and bare shoulders, arms, legs and feet, 30 minutes before outdoor activities. It is my responsibility to provide sunscreen with a minimum SPF of 15.

    I understand that I must provide the sunscreen in its original container labeled with my child’s name and within the noted expiration date. Sunscreen will not be applied to any broken skin or if a skin reaction has been observed. Any skin reaction observed by staff will be reported promptly to the parent/guardian.

  • Child's Doctor

  • Child's Dentist

  • Child's Medical Information


  • Our camp staff will dispense prescription medication only with consent of the child’s doctor. If you need the museum to dispense medication to your child PLEASE HAVE THE CHILD'S PHYSICIAN FILL OUT A MEDICATION ADMINISTRATION FORM. Additionally, if your child uses an inhaler, our camp staff must receive parental notification.
    Please complete the following inhaler authorization if necessary.
  • AUTHORIZATION FOR EMERGENCY MEDICAL CARE

    I hereby give my permission for the staff of Mizel Museum to call a doctor or the emergency medical service and for the doctor or emergency technicians to provide emergency or surgical care as needed for my child in the case of injury or illness. I will be responsible for all the expenses associated with medical care that my child may receive.

    ASSUMPTION OF RISK AND WAIVER OF LIABILITY

    I understand that participation in a camp sponsored by Mizel Museum will involve outdoor and other activities that my present risks. I agree that: a) We accept the risks of having my child participate in the camp; b) We waive and release any claim we might otherwise have against Mizel Museum, or any other person or entity that owns any real or personal property used in the camp or any of their respective employees, volunteers, directors, sponsoring agencies or representatives, for any personal injury or property damage sustained in the course of or in connection with my child’s participation in the camp, whether or not resulting from the negligence of any person or facts or conditions that would give rise to premises liability. We agree not to bring suit on any claim covered by the waiver.

    Your child will be required to follow the instructions of the Mizel Museum staff members who operate the camp. If your child does not follow instructions or if our staff members determine, in their sole judgment, that your child’s behavior is disruptive or is endangering your child, other persons or property, we will call you or another contact person designated above, and you will be responsible for picking up your child within one hour after the call. Depending on the severity of the problem, your child may not be allowed to return for the rest of the camp session, in which case you would not be entitled to a refund. You will be responsible for all expenses, damages or injuries caused by your child.

    By submitting this form, you acknowledge you have read and understood the material herein and are authorized to sign/submit this form as parent or legal guardian of the child named here.

  • This field is for validation purposes and should be left unchanged.