OSS Registration 2022

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? *

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.
If all are allowed, please type "all allowed"
By signing your full name below, you agree to allow Oregon Summer Star 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.

Communicable Diseases Statement and Liability Release
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".
Signature *

Clear

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

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.
By signing your full name below, you agree to the following: "I sign on behalf of myself or my participant 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 *

Clear
While our comprehensive liability waiver includes a section on photo, video, and audio release, we know that some families may prefer that we do not use their child's image. If you select "No" on the question below, we will ensure that no photos, videos, or audio recordings where your child is identifiable are used on our social media or other promotional materials.
Can we use media where your child is identifiable on social media or other promotional materials? *

Yes No

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.

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

Payment
Grant and Scholarship Information

Families currently experiencing deployment or with a Severly Injured Service Member / Veteran as a parent are eligible to apply for a grant from Our Military Kids (not affiliated with TSUGA) which would cover 100% of camp registration including the deposit.

All grants are subject to availability of funds. Our Military Kids requires ALL information and documentation to process an application. Applicants must meet all the criteria in order to apply. It takes up to (2) weeks to process a grant application. ***Please be aware that they only provide ONE grant per deployment to ONE organization.***

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All families, regardless of deployment status, are eligible to apply for an Oregon Summer Star scholarship. Funds are limited but we will do our best to grant at least a partial scholarship to all applicants. To apply for an OSS scholarship, click here.

My Products

Camper - Non-Refundable Deposit Only $ 51.85

Payment Plan

Camper - Full Regular Registration $ 414.00

Associate Counselor - Non-Refundable Deposit Only $ 51.85

Camper - Our Military Kids Grant / Full Scholarship Free

Select this option ONLY if you will be completing the Our Military Kids grant application OR applying for a full scholarship from OSS. Links for both applications are at the end of this form.

Total $ 0.00

Credit Card

Should be Empty:

2022 Participant Information Form

Food Restrictions and Allergies

Participant Special Needs

Health Insurance & Medications

Communicable Diseases Statement and Liability Release

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

Parent/Guardian Information

Emergency Contact Information

Anything We Missed?

Payment

Credit Card