Form

Form
Campers Name

First NameLast Name
Campers Age
Gender
Mothers Name

First NameLast Name
Fathers Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mothers Phone
Please enter a valid phone number.
Fathers Phone
Please enter a valid phone number.
EMERGENCY CONTACT AND PHONE NUMBER
EMERGENCY CONTACT AND PHONE NUMBER
MY CHILD IS ALLERGIC TO:
Tshirt Size

PHOTO RELEASE
From time to time photographs, videos and/or audio clips may be taken of youth and adults engaging in Country Kids Camp activities. Country Kids Camp requests the right to use all [hptps, videos, and/or audio clisps taken of program participants, programs and activities. These may be used for promotional brochures, promotions or showcases of programs, Facebook and on our website, showcase of activities in newspapers, and other non-profit purposes.

By signing this form, I consent to allow Country Kids Camp to use photos ,videos, and/or audio clips that they have of my child participating in Country Kids Camp activities.

By signing this form, I confirm that I understand and agree to the above request and conditions. I agree to give up my rights with regards to photos, videos, and/or audio clips of me. I sign this form freely and without indecuement.
PHOTO RELEASE

I GIVE YOU PERMISSION TO PHOTOGRAPH.I DO NOT GIVE YOU PERMISSION
Child's Name

First NameLast Name
Email
example@example.com
Parent/Guardians Name

First NameLast Name
Signature

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RELEASE OF LIABILITY
I hereby give my permission for my child(ren) to participate in the Country Kids Camp (the “School”) Summer Program (“Summer Camp”).
Participation in any program which involves physical activity exposes the camper to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers.
I hereby affirm that my child(ren) has/have no conditions that would make it unsafe for him/her/them to participate in the camps program(s) selected. I understand and acknowledge that I am responsible for reviewing the School’s health and safety protocols for Summer Camp and ensuring that Iand my child(ren) follow those protocols.
I understand that the School may exclude my child(ren) from Summer Camp in the event that I or my child(ren) fail to abide by the School’s health and safety protocols, disrupt, impede or interfere with the operations of the Summer Camp, or threaten the health, safety or welfare of other participants or Summer Camp staff, and that no refund of any fees will be made in such circumstances.
Medical Consent: I understand that the School will make every effort to contact me in the case of an emergency. I give my permission for the School to administer any medications needed and to provide and arrange for and consent to any necessary medical treatment for my child(ren) while at the School, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical
treatment.

By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren), I hereby voluntarily release and forever discharge the School, its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial
responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child(ren)’s participation in Summer Camp. I agree, for myself and my child(ren), not to make any type of legal or equitable claim on the School, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my child(ren) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with the School, including other campers. I further agree that if any such claim is made, I will indemnify and defend the School with respect to any such claim, injury or damage.
MEDICAL CARE*
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PHOTO RELEASE

RELEASE OF LIABILITY