Student Camp Application

STUDENT CAMP APPLICATION

Camper Information

Student Name:

Date of Birth:    Student ID:

Primary Phone:    Email:

Session & Program Selection

Program Name:

Week 1 — Day / Date(s) as listed by camp     Week 2 — Day / Date(s) as listed by camp     Full Session

Parent / Guardian Information

Relationship:    Phone:

Emergency Contacts

Relationship:    Phone:

Relationship:    Phone:

Medical Information & Authorizations

Physician Phone:    Insurance Provider:

I authorize camp staff to administer the above medications and routine first aid as needed:

Activity Permissions & Consent

I permit my child to participate in routine camp activities including outdoor recreation, arts and crafts, and supervised group games:

Swimming/Water Activities (if available): I consent to my child participating in swimming and other water-based activities under licensed or qualified supervision:

Off-site Field Trips & Transportation: I authorize my child to be transported and to attend scheduled off-site activities supervised by camp staff:

Photos / Video Release: I grant permission for my child's image and likeness to be used by the camp for promotional, educational, or archival purposes unless I opt out below:

If you opt out of photo release, state restrictions or special instructions:

Fees, Payment & Cancellation

Tuition Amount:    Deposit Amount:

Full payment due prior to start date     Installment plan (details on invoice)

Cancellation and Refund Policy: By signing this application I acknowledge that cancellations must be submitted in writing. Refunds, if any, are issued according to camp policy and may exclude non-refundable deposit and administrative fees. I further understand that failure to attend does not constitute a valid basis for full refund unless otherwise agreed in writing by camp administration.

I acknowledge and agree to the fees and cancellation terms:

Code of Conduct & Discipline

Camp maintains a code of conduct requiring respect for staff, peers, facilities, and program rules. Serious or repeated misconduct may result in dismissal from the program without refund. By signing below, I agree that my child will comply with staff directions and camp rules and that disciplinary measures may be applied when necessary.

I have reviewed and agree to the camper code of conduct:

Release, Assumption of Risk & Indemnification

In consideration for acceptance into the program, the undersigned acknowledges that participation in camp activities involves inherent risks, including physical injury. The undersigned hereby releases, waives, and discharges the camp, its directors, employees, volunteers, contractors and agents from any and all liability, claims, demands, actions or causes of action for personal injury, illness, property loss, or wrongful death arising from participation except where caused by the gross negligence or willful misconduct of the camp. The undersigned further agrees to indemnify and hold harmless the camp for any claims brought by third parties arising out of the participant's actions.

This release is intended to be interpreted broadly to provide a release and waiver to the maximum extent permitted by law. If any portion of this release is held invalid, the remainder shall continue in full force and effect.

Emergency Medical Authorization

In the event of a medical emergency and reasonable attempts to contact the parent/guardian have been unsuccessful, I authorize camp staff to secure emergency medical care for my child and to consent to any necessary medical treatment, including hospitalization, anesthesia, or surgery, as deemed necessary by licensed medical personnel.

I authorize emergency medical treatment as described above:

Additional Information

Acknowledgment & Certification

By signing this application, I certify that the information provided is true and complete to the best of my knowledge. I understand and agree to abide by all camp policies, emergency procedures, and the commitments set forth in this application. I acknowledge that failure to disclose accurate medical or behavioral information may jeopardize my child's participation.

I certify that I have authority to enroll the camper named in this application and to provide the consents and authorizations contained herein:

Signature

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