OSS OTR 2020

Who referred you?
Previously Registered Participant(s)

Please enter the legal name of each participant who was already registered for OSS 2020. If you have an additional participant who was NOT already registered, you will be directed to another page to complete their information and waivers.
Participant #1

First Name Last Name
Do you have any updates to this participant's information (medical history, special needs, etc.) since completing the registration form?
Participant #2

First Name Last Name
Do you have any updates to this participant's information (medical history, special needs, etc.) since completing the registration form?
Participant #3

First Name Last Name
Do you have any updates to this participant's information (medical history, special needs, etc.) since completing the registration form?

1st New Participant Information

Complete this page for the participant who was NOT previously registered for our 2020 overnight program. We already have this information for any participants who WERE previously registered. Note: You should only be able to see this page if you indicated that you had at least one new participant to register.
Legal Name:

First Name Last Name
Birth Date:

Month Day Year
Grade Level (in the fall of 2020)
Select Camp shirt size:

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

Participant Food Restriction, Allergies, & Medications

Although you will be providing sack lunches for your children, we plan to provide a pre-packaged afternoon snack.
Dietary Restrictions

None Vegetarian Vegan Gluten-free Kosher Halal
Does your participant have any allergies (food or otherwise)? If yes, please list them and describe the severity. If not please write "none."

Health Insurance & Medications
Please complete the following information about you child's health insurance, physician, and current medications. All medications and OTC are administered by our camp nurse, we will return all unused medications at the end of the week.

Medications MUST be in their original containers and include your child's name.
Health Insurance Policy
Company and Policy ID
Physician's Name
Physicians Phone Number

Area Code Phone Number
Is the participant currently taking medication that will need to be administered at camp?

Yes No
If yes, please list each medication and directions for administering the medication.
Will there be a change in medications schedule during the time they are at camp?
i.e. starting a new medication, getting off a medication, changing dosage, etc
Over-the-Counter Medication Release

Health Departments and other parties require camps to obtain written permission to administer specific over-the-counter treatments used for common ailments such as headache, poison oak, upset stomach, or diarrhea. Dosage will be administered according to official directions written on the product unless otherwise directed by official physician instructions for the following:
Please indicate any of the above listed OTC medications that CANNOT be given to your participant(s).
If all are allowed, please type "all allowed"
By signing your full name below, you agree to allow Tsuga Community Commission staff to give your participant the above medication(s) at the given times and route indicated and to administer the indicated over-the-counter medications if necessary for your child.
Signature
Is there any additional information not covered above or within your child's health history that may be useful to camp staff when working with your child?
Please describe it here.

Parent/Guardian Information

This person will be listed as the participant's main contact in case of emergency. Please do not use this name for the emergency contact person.
Parent/Guardian 1 Name:

First Name Last Name
Contact Phone Number:

Area Code Phone Number
E-mail Address 1:
Primary Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian 2 Name:

First Name Last Name
Contact Phone Number:

Area Code Phone Number
E-mail Address 2:

Emergency Contact Information

Please complete information for at least one ADDITIONAL emergency contact. In the event of an emergency, we will contact the parents/guardians in the order they are listed on the form, followed by the additional emergency contact(s).
Emergency Contact 1:

First Name Last Name
Emergency Contact 1 Phone Number:

Area Code Phone Number
Relationship to Participant:
Emergency Contact 2 :

First Name Last Name
Emergency Contact 2 Phone Number

Area Code Phone Number
Relationship to Participant:
Is anyone else authorized to pick up your participant from camp? If so, please list their first and last names.
Do not enter guardians/emergency contacts again.

Photo, Motion Picture, and Audio Release / Comprehensive Liability Release
SIGNATURE -- By signing your full name below, you agree to the following: "I sign on behalf of myself or my participant(s) and we agree to the potential use of image or audio recordings as set forth above, and permanently waive my rights to sue Tsuga or their affiliated partners for any reason. I have read this release before signing it and understand the contents, meaning, and impact of this release."
Signature

Full Release of Liability
The named camp participant and his / her parent or guardian (if applicable), hereby grant permission to the Tsuga Community Commission to be photographed and / or otherwise have images or voice recordings made (including but not limited to digital photographs, video or digital moving images, or voice recordings) for TCC publication or promotional purposes. I authorize the above named to be used in any medium (including but not limited to print media, newspaper, television, video, motion picture, or internet web site). I consent to the use of my or the program participant’s name or interview comments in connection with TCC publication or promotional purposes in print media, newspaper, television, video, motion picture, or Internet publication. In addition, I / we waive the right to inspect or approve draft or finished products, including written or electronic copies, wherein my likeness appears. I / we waive any right to royalties or other compensation arising or related to the above-described actions. I / we hereby hold harmless and forever discharge the Tsuga Community Commission from all claims, demands, and causes of action which I, our heirs, representatives, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. To the fullest extent permitted by law, I hereby waive any rights I may have to sue the Tsuga Community Commission or the Camp Staff Coalition (TCC) involved with the coordination and execution of programming. This includes involvement and / or participation in the following programs: Tsuga Community Commission Oregon Summer Star Program I understand this permanent waiver of my rights to sue TCC for any reason stands with respect to personal injury, property damage, emotional affects, civil rights violations, or any other experience of concern as a result of my child’s participation in programming. I hereby release TCC from any and all liability in every case and agree to use and exhaust any and every insurance policy unrelated to TCC prior to filing a claim associated with TCC or the liability coverage of their programs.

Communicable Diseases Statement and Liability Release
SIGNATURE -- By signing your full name below, you agree to the following: "I sign on behalf of myself or my participant(s) and I acknowledge that staff and/or other participants are capable of carrying and/or spreading infectious and/or contagious bacteria, viruses, and/or other communicable diseases, including but not limited to coronaviruses and/or COVID-19, that Oregon Summer Star has no control over. I understand that Oregon Summer Star will not be responsible if I, or my child and/or legal ward if applicable, become sick and/or ill due to any bacterial, viral, or other communicable disease infection, including but not limited to any coronaviruses and/or COVID-19. I further understand that I will not hold Oregon Summer Star responsible for any preventative measures taken or not taken to minimize the spread of such bacteria, viruses, and/or other communicable diseases. I understand I am solely responsible for taking measures to prevent myself, or my child’s and/or legal ward if applicable, from becoming sick and/or ill while participating in Oregon Summer Star programming and related gatherings. I expressly assume any risk, whether currently known or unknown, of becoming sick and/or ill that may or may not be caused due to participating in the activities and services that Oregon Summer Star has provided me or my child and/or legal ward, if applicable".
I have read and agree to the terms listed above
Please type your FULL NAME and TODAY'S DATE
Signature

Anything We Missed?
Is there anything we need to know about your camper(s) that we have not covered with this form?
E.g., Siblings at camp, previous camp experience, etc.

Payment

This is a pay-what-you-can program with a suggested donation of $40 per camper to offset operating costs. We appreciate whatever you are able to give at this time! Payments are processed through STRIPE and the charge will show up as Tsuga Community Commission.
Registration is not complete until the "submit" button is clicked and you are redirected to tsuga.org page with camp information.
How will you make your donation?

Submit a payment now via Stripe Bring cash or check to camp drop-off I have already requested to donate some or all of my pre-paid registration fees I am not able to donate at this time

Donation Amount

USD Description

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

OSS On The Road Registration

Previously Registered Participant(s)

1st New Participant Information

Participant Food Restriction, Allergies, & Medications

Participant Special Needs

Health Insurance & Medications

Parent/Guardian Information

Emergency Contact Information

Photo, Motion Picture, and Audio Release / Comprehensive Liability Release

Communicable Diseases Statement and Liability Release

Anything We Missed?

Payment