SSC Camper Application

It's time to apply for Sawyerville Summer Camp!

Please read the following information and the information found on our website (click here) even if you have attended camp before! Please take time to fill out this application as accurately as possible.

Applications for a session will not be accepted after the first day of each session. Make sure to submit an application for each one of your campers!

Campers can be any child that is an upcoming 1st through 8th grader, or ages 6 through 14. Campers must also be 6 by September 1st and may not be 15 or older by September 1st. Those that are 15 years old may apply to be a CIT (Counselor-in-Training) here. The camper age range of 6-14 years old is in place because Sawyerville best feels our programs cater to this age group.

Please only submit one application for each camper. Campers are only guaranteed to come to one session. However, if you would like your camper to attend two or more sessions, they may be placed on a waitlist for available spots.

Camp is completely free and located at Greensboro Elementary School in Hale County. You will be notified what session your camper has been placed in near the end of May or Mid-June depending what session your camper will attend.

Need a hard copy? Email kana@sawyerville.org

Questions?

Kana Goldsmith, kana@sawyerville.org

Carrie Dennis, carrie@sawyerville.org

Name*

First NameLast Name

Gender*

MaleFemaleOther

Birthdate*

Date

Upcoming School Grade*

Upcoming School Name*

Confirmed Sessions

Session 1Session 2Session 3

Checked In?

Session 1Session 2Session 3

Session Preference*

Session 1Session 2Session 3

Added to waiting list for session(s)

Session 1Session 2Session 3

Family that needs to be at your session*

Bathing Suit Size*

T-Shirt Size*

Camper Before?*

Camper Phone Number*

Please enter a valid phone number.

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Physical Address*

Physical Street Address

Physical Street Address Line 2

Physical CityPhysical State / Province

Physical Postal / Zip Code

Mobile Phone Number (Daytime Phone)*

Please enter a valid phone number.

Home Phone Number (Evening Phone)*

Please enter a valid phone number.

Primary Contact Name*

Primary Contact Relationship to Camper*

Primary Contact Phone Number*

Please enter a valid phone number.

Primary Contact E-mail*

Emergency Contact Name*

Emergency Contact Phone Number*

Please enter a valid phone number.

Transportation type*

Bus RiderCar RiderWalker

If Bus Rider, which bus stop?

If Car Rider, Car Number

Authorized Pickup Name*

Authorized Pickup Phone Number*

Please enter a valid phone number.

Authorized Pickup Name #2

Authorized Pickup #2 Phone Number

Please enter a valid phone number.

Medications at camp?*

Allergies?*

Type "N/A" if there are no dietary restrictions/allergies

Illness?*

Type "N/A" if there are no illnesses

Primary Doctor*

Primary Doctor Phone Number*

Please enter a valid phone number.

Insurance Type*

Policy Number*

Group Number*

A parent/guardian must be present when filling out this portion of the application and sign the consent forms below. The Parent/Guardian electronic signature below and in all related fields of this application are received in faith and treated by the Episcopal Diocese of Alabama as a hand-written signature by the parent/guardian on a signed physical paper form. I affirm that all information provided in this application is true and accurate to the best of my knowledge.

This health history is complete and accurate and the camper has permission to engage in all activities unless otherwise specified in writing. I understand that there is a risk of injury to my camper while participating in summer camp activities.

I understand and agree that Sawyerville Summer Camp assumes no responsibility for injuries or illnesses which camper may sustain as a result of his/her participation in Summer Camp activities.

I expressly acknowledge that I assume the risk for any and all injuries and all illnesses, which may result from camper’s participation in these activities.

I agree to indemnify and hold harmless the Episcopal Diocese of Alabama and Sawyerville Summer Camp, their staff, and volunteers for accidents or injuries arising from camper’s participation in their camp activities.

I agree to have camper examined within a reasonable time period prior to camp by the family physician or local clinic stating he/she is free of communicable disease and has not been exposed to such.

In the event that I cannot be reached in an emergency, I hereby give permission to the medical professional selected by the Sawyerville Summer Camp director to secure and administer treatment including hospitalization for camper. I give permission for the camp’s designated medical professional to give over-the-counter medications and treatment.

I understand that no accident or medical insurance is provided with this activity.

I give permission to Sawyerville Summer Camp, without limitation or obligation to use photographs, film footage, or tape recordings which may include camper’s image or voice for purposes of promoting or interpreting its programs and release Sawyerville Summer Camp from any claim of liability for that use.

I give my consent for my child to leave the Sawyerville Summer Camp site, Greensboro Elementary, to participate in authorized trips and to ride in authorized vehicles for the purpose of transportation in connection with the Summer Camp program.

I give camper permission to participate in water activities provided by the Sawyerville Summer Camp.

I understand the Sawyerville Summer Camp staff and volunteers are not permitted to transport campers in their personal vehicles unless it is in the case of seeking medical attention—in which case the Director, Assistant Director, or member of summer-long staff will be present.

I understand camper(s) will only be allowed to leave or be picked-up by an authorized person. Any person authorized to pick-up camper must be listed on the Sawyerville Summer Camp permission form or arrangements in writing must be submitted to the office. All authorized people must be OVER 18 years of age and be able to provide proper photo identification.

I agree to terms and services

Camper Release Form Received*

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Signature*

Date*

Date

Camper Application

General Information

Camper Medical Information

Release Form