Summer Camp Parental Consent

FUNdamental Math Summer Camp 2022 - Wellford SC

Registration Form
Participant 1's Full Name *

First Name Last Name
Participant 1's Birth Date *

Month Day Year
Date
Participant 1's School *
Participant's 1's Email
example@example.com
Participant 1's Grade Level in 2022-2023 School Year *
Participant 1's Allergies or medical issues *
(If the child has no allergies, please enter None.)
Participant 1's T-shirt Size *
Participant 2's Full Name

First Name Last Name
Participant 2's Birth Date

Month Day Year
Date
Participant 2's School
Participant 2's Email
Participant 2's Grade Level in 2022-2023 School Year
Participant 2's allergies or medical issues
Participant 1's Allergies or medical problems
Participant 2's T-Shirt Size

Consent Form
1. Transportation
Parents or guardians are responsible for securing the rides to and from the Summer Math Camp for their child(ren). Camp hours are from 8:00 a.m. to 12:00 p.m.
2. Requirements
By providing your signature below, you ceritify that the child named above is in good health and has no physical or medical limitations that would cause daily camp activities to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in designated section above.
3. Consent
You hereby attest that you are the legal parent(s)guardian(s) of the above-named child and hereby consent to the child(ren)'s participation in the activities associated with the camp.
4. Insurance
By providing a signature below, you understand that FUNdamental Math LLC does not carry any insurance relative to the activities or for any injury that may occur to the above-named child(ren). You confirm that the child(ren) is/are (a) covered by insurance through your own insurance carrier; or (b) that you are personally and financially responsible for any and all medical costs incurred as a result of the child(ren)'s injury.
5. Emergencies
If the above-named child(ren) require(s) any emergency medical treatment or procedures during the activities, you hereby consent to and authorize the activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).
6. Release and Identification
You release and waive, and further agree to indemnify, hold harmless FUNdamental Math, the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which you, any other parent or guardian, any sibling, the above-named child(ren), or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child(ren)'s participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.
Parent/ Guardian Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian E-mail
Home Phone Number

Area Code Phone Number
Parent/Guardian Work Phone Number

Area Code Phone Number
7. Emergency Contacts
If, in the event of a medical or other emergency, you unable to be reached by telephone at your home or work telephone numbers listed above, you authorize the activity supervisor(s) to attempt to contact you through the emergency contacts listed below:
Emergency Contact #1 Name *

First Name Last Name
Relationship *
E-mail *
Home Phone Number

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Emergency Contact #2 Name

First Name Last Name
Relationship
E-mail
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions. *

I agree
Date *

Month Day Year
Are you interested in volunteering?

Yes No
Camp Registration Fee

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USD (Note that the tuition fees are $175 for each participant.)

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FUNdamental Math Summer Camp 2022 - Wellford SC

Consent Form

1. Transportation

2. Requirements

3. Consent

4. Insurance

5. Emergencies

6. Release and Identification

7. Emergency Contacts