L.E.G.I.T. KIDS SUMMER CAMP

L.E.G.I.T. KIDS CAMPER REGISTRATION
Camper Information
Camper 1: *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date: *

Month Day Year
Age: *
Grade Completed:
Known Allergies:
Medications, Dosage, Frequency:
Please elaborate on other chronic condition or major illnesses of child. If necessary, state proper care for child as well as procedures to follow:

Camper 2:

First Name Last Name
Address if Different from Camper 1:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date:

Month Day Year
Age:
Grade Completed:
Known Allergies:
Medications, Dosage, Frequency:
Please elaborate on other chronic condition or major illnesses of child. If necessary, state proper care for child as well as procedures to follow:

Camper 3:

First Name Last Name
Address if different from Camper 1

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date:

Month Day Year
Age:
Grade Completed:
Known Allergies:
Medications, Dosage, Frequency:
Please elaborate on other chronic condition or major illnesses of child. If necessary, state proper care for child as well as procedures to follow:

Parent/Guardian Information
Parent/Gardian: *

First Name Last Name
Relationship to Camper:
Address if Different From Campers:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
E-mail: *
Second Parent/Gardian:

First Name Last Name
Relationship to Camper:
Address if Different From Campers:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
E-mail:
example@example.com

Emergency Contact (other than Primary Guardian): *

First Name Last Name
Emergency Contact Phone: *

Area Code Phone Number
Authorized Pick Up #1 *
Relationship to Camper: *
i.e. Mother, father, grandparent, neighbor
Phone Number *

Area Code Phone Number
Authorized Pick Up #2 *
Relationship to Camper: *
i.e. Mother, father, grandparent, neighbor
Phone Number *

Area Code Phone Number

Parental Consent and Liability Waiver
Field Trip Consent

I give my son/daughter permission to attend the L.E.G.I.T. Kids activities that will not take place on the Adventist church property (i.e. Pool, Lake, park, etc.). I herewith release and hold harmless L.E.G.I.T. Kids of any claims of personal injury.

Permission for Medical Treatment
In the event of an emergency occurring while my son/daughter is at L.E.G.I.T. Kids on the grounds of the hosting Seventh-day Adventist church and public facilities used by the camp, I hereby grant permission to the camp and to its employees to take whatever action
deemed necessary.
In the event that I cannot be reached, I hereby authorize the camp and/or its employees to give consent for my son/daughter to receive medical treatment.
Family Doctor
Doctor's Phone Number
Hospital/ Medical Facility Preference:
Additional Comments:
1. Insurance
I fully understand L.E.G.I.T. Kids, a program of the Bucks County Seventh-day Adventist Church does not provide any accident or health insurance coverage for my son/daughter. I fully understand that it is my responsibility to provide accident insurance coverage for my child.

2. Liability
As the parent or guardian of a minor child participating in activities of L.E.G.I.T. Kids, a program of the Seventh-day Adventist Church, I hereby waive and release any claims I, or my child may have against L.E.G.I.T. Kids, the local hosting church, and its employees
arising from injuries to my child or damages to my child’s property, under the care of L.E.G.I.T. Kids. I further understand that L.E.G.IT. Kids is neither certified nor licensed as a day care provider. In the event of any injury to my child to a medical facility, and/or provide my child with emergency treatment or first aid. I understand that L.E.G.I.T. Kids does not assume any unstated written/responsibilities to take care of any emergencies beyond the scope of the L.E.G.I.T. Kids program.

3. Technology
MP3 players, cell phones, etc. are not permitted. We ask that each camper leave these items at home. Under the circumstances that these items are brought to camp, L.E.G.I.T. Kids and/or its employees will not be held responsible for any loss or damage.
When a child is seen using such technology without permission they will be asked to put it away on first offense and confiscated to be returned at the end of the day on the second offense. If you need to contact your child during the day, please contact the L.E.G.I.T. Kids
Director and / or the Assistant Director.

4. Emergency
In case of accident or serious illness the adult in charge will try to contact me at the number given on this form. If the adult in charge is unable to contact me, I hereby authorize the camp director or staff member to take my child to the physician indicated or
the nearest medical facility. These waivers and releases shall be valid for the duration of the session in which my child is
enrolled. I have carefully read this waiver and release and agree to the terms stated. The Accident Waiver and Release of Liability Form shall be constructed broadly to provide a release and waiver
to the maximum extent under applicable law.

I certify that I am the parent or legal guardian of the child /or children listed above. I verify that the information I have provided is correct and current.
Parent's Name: *

First Name Last Name
Date:

Month Day Year Hour Minutes AM/PM Option
1. By submitting this form, I CERITIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
2. By submitting this form I GIVE CONSENT FOR MY CHILD TO GO ON FIELD TRIP AND PERMISSION FOR MEDICAL TREATMENT.
Should be Empty:

L.E.G.I.T. KIDS CAMPER REGISTRATION

Camper Information

Parent/Guardian Information

Parental Consent and Liability Waiver