Student Camp Forms

STUDENT CAMP FORMS

Camper Information

Camper Name:

Date of Birth:    Student ID (if applicable):

Grade / Program:    Gender:

Parent / Guardian Information

Emergency Contact & Authorized Pickup

Medical Information & Consent

I authorize camp staff to administer the medications listed above in accordance with written instructions provided by the parent/guardian and acknowledge that staff are not medical professionals.

I authorize camp staff to administer routine non-prescription medications (e.g., acetaminophen, ibuprofen, antihistamines, antacids) as needed for common ailments in accordance with dosage guidelines.

In the event of illness or injury, I authorize the camp to obtain necessary emergency medical treatment for the camper named above, including transport to an emergency facility, and to provide this signed form to medical personnel. I agree to be financially responsible for all costs of such treatment not covered by insurance.

Camp Session & Transportation

Camp Session Name:

Session Dates: From to

I consent to camper participation in routine off-site activities and transportation provided by the camp (e.g., field trips), and acknowledge that the camp will use reasonable care in arranging transport.

Media Release & Privacy

I grant permission for photographs, video, and audio recordings of the camper taken during camp activities to be used for promotional, educational, and archival purposes by the camp (print, electronic, and social media), provided that no personal contact information is published without separate consent.

Payment, Fees, and Cancellation Policy

All fees must be paid according to the schedule provided at registration. Cancellation requests must be submitted in writing. Deposit is non-refundable except where expressly required by law. Additional charges for late pick-up, supplies, or special activities may apply and will be billed to the parent/guardian.

Behavioral Expectations & Release of Liability

I acknowledge that participation in camp activities involves inherent risks of physical injury. By signing below, I voluntarily assume all risks associated with participation and release, waive, and covenant not to sue the camp, its officers, employees, volunteers, and agents from any and all liability for any injury, loss, or damage to person or property arising from the camper’s participation, except where such liability cannot be waived by law.

I further agree to indemnify and hold harmless the camp for any claims, damages, or expenses (including reasonable attorneys' fees) arising out of the camper’s negligent or intentional acts. The camp reserves the right to dismiss a camper whose behavior endangers the safety of others or materially disrupts program activities; dismissal is without refund unless otherwise determined in the camp’s sole discretion.

I have reviewed and agree to abide by the camp rules, discipline procedures, and behavior expectations set forth by the camp.

Acknowledgment and Certification

I certify that all information provided on this form is true and complete to the best of my knowledge. I understand that failure to disclose medical or behavioral information relevant to camper safety may result in removal from camp activities without refund.

By signing below, I attest that I am either the parent or legal guardian of the camper named above, or an adult camper eighteen (18) years of age or older, and that I have the authority to provide the consents and releases set forth in this form.

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