2026 Hands on History Summer Day Camp

Limited Power of Attorney: Consent of Treatment of Minor and Release of Liability

1. I/We, the undersigned, hereby appoint the Iowa Heartland History Connection (IHHC) and each of its authorized agents, each to act alone, and medical care (except elective surgery) of [Camper's Name] determined to be necessary or desirable by our child's attending physician at the hospital in which emergency treatment and/or medical care is sought.
2. I/We, the undersigned, give permission to IHHC and each of its authorized agents to administer over-the-counter medication to [Camper's Name] should this be deemed necessary. Additionally, all physician-prescribed medications will be dispensed to the camper only if the prescription is contained in its original prescription bottle and only for the exact dosage prescribed on the bottle by the physician.
3. This Power of Attorney shall continue until revoked by the undersigned, or for one (1) year after its date, whichever is earlier. The attending physician(s) or the attending hospital's medical staff may assume and rely that this authorization is currently in effect during such one (1) year unless notified.
4. I/We, the undersigned, release IHHC and any of its authorized agents from any obligation or liability, actual or implied, concerning their use of the limited purpose power of attorney.
5. The undersigned certify that they have read the Power of Attorney and Release of Liability (or had it read to them) and that they understand the same.