URU ADVENTURE CAMP PARENT CONSENT AND MEDICAL FORM

URU ADVENTURE CAMP PARENT CONSENT FORM
Camper's Name*
Photo Consent

By enrolling my child in Uru Adventure camp, I give Uru Adventure Camp permission to take photos and videos of my child during daily activities for use in camp related websites, emails and

Trip Consent

I give permission for my child to attend camp and participate in all phases of the Uru Adventure Camp program including off-campus field trips when they apply. Weekly field trips may include overnight camping, biking and hiking as well as the transportation to and from those sites. I understand that the staff will exercise reasonable care to ensure my child's safety. Adults accompanying the group will provide supervision and will exercise reasonable care to avoid accidents. By signing below I am granting my child permission to attend weekly field trips and agree to the terms discussed above.

Parent Consent and Release

I am aware and understand that the activities included during the Uru Adventure Camp (including overnight camping, biking, hiking, water activities, and other activities) involve inherent risks and may result in personal injury or death. I am fully informed about the risks associated with participation in the activities and consent to our child's participation in Uru Adventure Camp and agree to indemnify and hold harmless Uru Adventure Camp, Daniel Moses, its employees and volunteers in case of injury.

I have carefully read this consent/release prior to its execution and I fully understand its contents.
Guardian's Signature*

Clear
Date*

MonthDayYear
Date

URU ADVENTURE CAMP MEDICAL & EMERGENCY RELEASE FORM

Must fill one form out for EACH camper.
Participant's Information

Be sure all medical and immunization forms are emailed to uruadventure@gmail.com if needed.
Child's Name*
Child's Age*
Child's DOB*

MonthDayYear
Date
Parents' Names*
Immunization Requirements

All children who attend Uru Adventure Camp must have current immunizations that are consistent with State of Maryland school requirements.
My child is registered at the following MD licensed school. *
Note: Attending a licensed public or private school in the state of Maryland verifies immunization. A Maryland Immunization Certificate must be emailed to uruadvenure@gmail.com if your child is not registered in a school or day care in the state of Maryland.
Health Information
Date of last Tetanus shot (must be completed for child to attend) *

MonthDayYear
Date
Are there any identified health issues (including but not limited to asthma, diabetes and epilepsy) that may need emergency treatment?*

NOYES ( If yes, please provide physician's statement)
Does your child require medication during the program hours? (An Authorization for Medication form must be attached if your child must receive medication during program hours.)*

NOYES
If yes, list medications and dosages here
Check all that apply: My child requires the use of an

InhalerEpi-Pen
An Authorization for Medication Form from the website must be attached if your child uses or carries one of the above.
Please list any and all allergies*
To help us serve your child better, does your child have any health problem(s) including physical, psychiatric, behavioral, or other problems. Please be specific. *
HEALTH INSURANCE COMPANY INFORMATION
Company Name (Medical Insurance): *
Policy Holder's Name (Provider):*
Policy #*
Group #*
Family Physician*
Phone*
PERMISSION FOR EMERGENCY MEDICAL TREATMENT

In case of a medical emergency or serious illness, and in the event that the parent/guardian cannot be immediately contacted I hereby authorize the Uru Adventure Camp staff to call the Physician indicated on this form and follow his or her instructions. If the physician can not be contacted, I consent to emergency medical treatment for our child and we assume liability for any expenses incurred in such an emergency (transportation, hospitalization, x-rays, etc), medical expenses incurred.
Guardian's Signature*

Clear
Date*

MonthDayYear
Date
Email
example@example.com
NOTE: If your child does not attend school in Montgomery County, then a copy of your child's complete immunization records must be provided to Uru Adventure Camp by law. Maryland's immunization records form can be downloaded from our website's form page.
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URU ADVENTURE CAMP PARENT CONSENT FORM

URU ADVENTURE CAMP MEDICAL & EMERGENCY RELEASE FORM