Summer camp Form

Child's Information

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Cell Number*

Home Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Date

Does your child have any special needs or sensitivities? If yes, please explain any instructions.

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Blooming Sun llc during the selected camp. In exchange for the acceptance of said child’s candidacy by Blooming Sun llc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Bloooming Sun llc . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in selected camp sessions. In case of injury to said child, I hereby waive all claims against Blooming Sun llc including all coaches, participants and if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured is low but not a guarantee in all activities.

Medical Release and Authorization As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named participant. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Blooming Sun llc.to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

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