JBF Fatherhood Retreat

Name*

First NameLast Name

Camper/Chaperone*

I, {typeA} {name} , hereby acknowledge that I am participating in the JBF Fatherhood Retreat and camp activities organized The Jack Brewer Foundation. I understand and agree to the following terms and conditions:

I am aware of any allergies or medical conditions that I may have.will provide accurate and up-to-date information regarding any allergies or medicalconditions that may require attention during the camp.

I understand that it is my responsibility to carry and self-administer any necessarymedication during the camp.In the event that I am unable to self-administer medication, I authorize designated camp staff to administer prescribed medication to me.

I will provide accurate emergency contact information to the camp organizers, including names, phone numbers, and any relevant medical information.I understand that this information will be used in case of any emergency during the camp.

I acknowledge that participation in camp activities involves inherent risks and potential hazards.I voluntarily assume all risks associated with camp activities and will not hold The Jack Brewer Foundation, Camp Timberline, Jack Brewer, or any camp staff responsible for anyinjuries or damages that may occur during the camp.

I will conduct myself in a respectful and responsible manner during the camp.I understand that any behavior deemed inappropriate or harmful may result in my dismissal from the camp without refund

In the event of a medical emergency, I authorize camp staff to seek emergency medical treatment on my behalf, including transportation to the nearest medical facility if necessary.I understand that every effort will be made to contact my emergency contacts before initiating medical treatment.

By signing below, I acknowledge that I have read and understood this waiver form and agree to its terms and conditions.

YesNo

Signature*

Guardian Signature*

Date*

Date

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Relationship*

Medical Insurance Provider*

Policy Number*

Allergy/Medical Information (if applicable):*

Please ensure that all campers and chaperones complete this waiver form and submit it to The Jack Brewer Foundation before the commencement of the camp activities. This information will be treated confidentially and used solely for the purpose of ensuring the safety and well-being of all participants during the camp.