Camp Permission Slip Form

Camp Permission Slip Form

Camp Details

Camp Name:

Camp Location:

Camp Dates: From to

Student Information

Parent / Guardian Information

Emergency Contacts (Other than Parent/Guardian)

Medical Information & Authorizations

Date of last tetanus booster:

Authorization to administer routine over-the-counter medications (e.g., acetaminophen, ibuprofen, antihistamines) as deemed appropriate by camp staff or medical personnel:

I hereby authorize staff to administer routine over-the-counter medications in accordance with dosage instructions and after notifying parent/guardian when feasible.

Authorization to administer prescription medication at camp as prescribed below:

I authorize camp personnel to administer prescription medication exactly as prescribed. If checked, provide medication and physician instructions on the attached label or in the additional instructions field.

Activities & Transportation

The following consents relate to participation in camp activities and transportation arranged by the camp.

I consent to my child's participation in routine camp activities including arts and crafts, hiking, low-element challenges, team sports, and supervised nature exploration.

I consent to my child's participation in supervised aquatic activities (where applicable) and certify that the child can participate unless otherwise noted in medical information.

I authorize transportation of my child by camp staff or agents to and from activities and designated pickup/dropoff locations.

Photo/Media Release

Camp staff may take photographs or video recordings of participants for use in camp publications, promotional materials, or educational displays. Please indicate your preference:

I consent to the use of photographs/videos of my child for camp promotional, educational, or archival purposes, without compensation.

I do NOT consent to the use of photographs/videos of my child for promotional purposes.

Acknowledgements, Release & Emergency Treatment Authorization

By signing below, Parent/Guardian certifies that all information provided is accurate to the best of their knowledge. Parent/Guardian acknowledges and agrees that participation in camp activities involves inherent risks which may include but are not limited to physical injury, illness, or property loss. Parent/Guardian voluntarily assumes all risks associated with participation.

Parent/Guardian hereby authorizes camp staff and any designated chaperone to obtain and consent to emergency medical treatment for the student if the Parent/Guardian cannot be reached. This authorization includes emergency diagnostic procedures, hospitalization, anesthesia, and surgery, if deemed necessary by licensed medical professionals. Parent/Guardian agrees to be responsible for all costs of such treatment and to indemnify and hold the camp harmless for actions taken reasonably to provide emergency care.

Parent/Guardian further releases and holds harmless the camp, its directors, employees, volunteers, and agents from any liability for injury, loss, or damage to person or property arising from ordinary negligence in connection with participation in camp activities, to the fullest extent permitted by law. This release does not extend to willful misconduct or gross negligence.

In the event of an emergency requiring medical treatment, I authorize the following emergency contact to make decisions if I am unavailable: Emergency Contact Name:

I have read and agree to the camp behavior expectations, safety rules, and procedures as provided by camp staff. I understand that failure to comply with rules may result in dismissal from the program without refund and that I am responsible for arranging immediate pickup.

I acknowledge receipt of the behavior expectations and agree that my child will comply with camp rules.

Additional Information

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