CamperReleaseForm_2023
This form must be completed online before June 1, 2023.
Camper Contact Information
Please check each camp your camper is attending this summer. Choose all that apply.
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Camp Kettleford (Bedford, NH)
Camp Seawood (Portsmouth, NH)
Camp Twin Hills (Richmond, VT)
Camp Farnsworth (Thetford, VT)
Camper Full Name
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Camper Date of Birth (mm/dd/yyyy)
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Camper Age
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Camper Address
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Parent/Guardian Name(s)
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Parent/Guardian Address (if same as camper, leave blank)
Parent/Guardian Email (This is the email we will use to send you a copy of this form)
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example@example.com
Parent/Guardian Phone(s) If multiple phone numbers, please list in the order we should call to reach a parent/guardian
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Emergency Contact Information
Camp guidelines require two additional emergency contacts, at least 18 years old, who may be contacted if parent/guardian(s) above are unavailable. Please list two emergency contacts.
Emergency Contact 1 (An adult, other than a parent/guardian listed above, who we can contact if the parent/guardian(s) are not available): Name, relationship to camper, and phone
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Emergency Contact 2 (An adult, other than a parent/guardian listed above, who we can contact if the parent/guardian(s) are not available): Name, relationship to camper, and phone
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If you wish to list other authorized adults to whom we can release your camper, please list their names here. Campers may only be released to parent/guardian(s), emergency contacts and adults listed here as authorized adults. All adults picking up campers must provide photo id.
Buddy request
Most girls come to Girl Scout camp as an individual, but some girls come to camp with a friend (a buddy). We try to place girls who come to camp with a buddy in the same group or unit. If your camper is coming to camp with a buddy, please tell us her buddy below. For more information and limitations, see the Family Handbook.
Camper Buddy Request
Day Camp Transportation
Seawood, Kettleford, and Twin Hills only
Campers at day camp may ride the bus or be driven to camp each day. Please let us know if your family is planning on using the bus, or driving to camp each day. If you are planning on taking the bus, please let us know which bus stop you are planning on using.
Girl Scout Program Permission and Activity Release
I hereby accept and abide by the provisions on the following statement: I am willing to have my camper be a Girl Scout member. I will not hold Girl Scouts of the Green and White Mountains responsible for loss of personal articles my camper brings to camp. I have read the council policies, registration information and financial obligations and agree to abide by them. I request that my camper be allowed to participate in the activities described for the program for which she is registered, and other camp activities deemed appropriate by the camp. I understand that activities at camp follow GSUSA Safety Activity Checkpoints, which may have age restrictions which impact my camper's participation. I understand that my camper’s participation in camp can expose her to dangers from both known and unanticipated risks. Acknowledging that such risks exist, I hereby release and discharge Girl Scouts of the Green and White Mountains, its officers, agents, and employees from any and all claims of liability for personal injury or property damage this camper may suffer while participating in the activity, including, but not limited to any claim arising out of any condition of the premises at which the activity is held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. I specifically agree to release and hereby release Girl Scouts of the Green and White Mountains and the officers, agents, and employees of the camp for any negligence of the camp, or its officers, agents, or employees.
Signature of Parent of Legal Guardian
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Camper Full Name
Camper Date of Birth (mm/dd/yyyy)
Camper Age
Girl Scout Camp Code of Conduct
Girl Scout camp gives campers an opportunity to grow, explore and have fun. It is our goal to help her build the courage, confidence, and character to take the lead and realize her full potential. To help strengthen this behavior in camp, we refer to the Girl Scout Promise and Law as our guiding principle and code of conduct: Girl Scout Promise On my honor, I will try: To serve God and my country, To help people at all times, and to live by the Girl Scout Law. Girl Scout Law I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout. We expect every girl and staff member at camp to model these behaviors, follow camp rules, and act as a sister to all camp participants. Campers who cannot follow these standards will receive a reminder of expected camp behavior. The camper will then develop a plan for changing their behavior. Behavior consequences are progressive and may include dismissal from camp. Should the negative behavior occur again, the camper will create a behavior modification plan with input from staff and parents/guardians. Should behavior continue after the development of a behavior modification plan, dismissal from camp without a refund is a consequence. Some actions are deemed to have a significant impact and will require immediate dismissal from camp without a refund. Physically and/or verbally abusive/harassing behavior, illegal drugs, marijuana, alcohol, tobacco, and clothing that promotes any of the above compromise our community and are not welcome at camp. Behaviors that are intentionally harmful, such as taunting, spreading rumors, excluding others from groups, endangering the safety of any camper, and verbal or physical aggression toward staff, adults, or campers may result in immediate dismissal from camp. Please review and sign below: · We have reviewed the Camp Family Handbook, and accept the policies and procedures outlined within. · We are prepared to be a sister to every Girl Scout, make an effort to get to know sister Girl Scouts in my unit and at camp, and find ways to be sure every girl is included in activities at camp. · We have reviewed the Girl Scout Promise and Law, and understand the behavior expectations for Girl Scouts at summer camp, including those behaviors which are taken very seriously, and may cause a camper to need to leave camp. · We have reviewed how to ask for help and support from camp staff, and when and who to tell if there is a problem. Problems might be getting along with another camper, not feeling well, missing family, or other situations where help or support is needed. · We have reviewed items which are prohibited at camp (cell phones, electronics, weapons, alcohol, drugs, tobacco, and pets) and will ensure none of these come to camp. By signing below, we promise to do our best to live by the Girl Scout Promise and Law at camp.
Signature of Parent or Legal Guardian
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Signature of Girl Scout Camper
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Submit
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