Summer Camp Consent Form
Name of Camper
First Name
Last Name
Age
Grade(going to)
Parent's Email
example@example.com
Camper's Date of birth
-
Month
-
Day
Year
Date Picker Icon
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-shirt Size
Please Select
Extra small
Smaill
Medium
Large
Extra Large
Double Extra Large
Would you be intersted in learning more about CTG Academy opening this fall?
yes, I am interested in my child attending CTG Academy this school year
no
Yes Im interested in hearing more
Medical Information
Does your child have special instructions for medical treatment? If yes, please explain including the medication your child is taking
Are there any activities that you wish your camper to not participate in? Please explain below
Does your camper have FOOD allergies? Any major health problem ie. Asthma, Seizures, Hay Fever? Please explain below
Name of Doctor
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Consent and Authorization
I, the undersigned, hereby declare and affirm that:
I am the parent/legal guardian of the youth named above (hereinafter referred to as "Child"), who is under my care and responsibility. I hereby consent and give authority to the participation of my Child in the scheduled youth activities of the Camp, and all other activities which is supervised and customarily associated with its youth group. I hereby declare and affirm that my Child is physically fit to take part in the Camp's activities and my Child has no known illness or adverse medical condition that would render him/her unfit to participate therein, other than the information specified in the medical information above. I shall immediately advise the organizers in writing, should I discover any illness, adverse medical condition, or any other physical defect that would render my Child unfit to participate in the recreational and sporting activities of the Camp. I shall notify the organizers immediately in case I revoke my consent to the Camp for this event.
Authorization for Medical Treatment
I understand that in case of medical emergencies involving my Child, I shall e notified right away. In case any of my provided contact information is unreachable, I authorize the organization to call the doctor indicated above. In case that the doctor is not available, I authorize the organizers to call any doctor to provide the necessary medical attention to my child. I understand that the camp shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.
Name of Parent/Guardian
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Signature of Parent/Guardian
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USD
camp fees
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