Please download the following physical form to be completed by your family physician. Physical must have taken place within the last year.

DOWNLOAD PHYSICAL FORM →

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Upload a scanned copy of the completed physical form below or mail a hard copy to:

Camp Get-A-Way
77 Commerce Dr, Ste 7
Rochester, NY. 14623

Consent for Emergency Medical Care and Emergency Contacts (required)

I, {name}, give my consent for Camp Get-A-Way, or any person acting as the agent for Camp Get-A-way to seek emergency medical care if an emergency should arise. 

Printed Name: {name}
Date of Birth: {date}

Liability Disclaimer (required)

I, {name}, hereby release Camp Get-A-Way, it officers, volunteers, and family participants from any liability that might occur while participating at Camp Get-A-Way’s summer experience. 

Printed Name: {name}
Date of Birth: {date}

Confidentiality Statement (required)

I, {name}, hereby release Camp Get-A-Way, it officers, volunteers, and family participants from any liability that might occur while participating at Camp Get-A-Way’s summer experience. 

Printed Name: {name}
Date of Birth: {date}

Consent for Taking and Releasing Photographs and Video (optional)

I, {name}, give consent to the taking of photographs and/or video recordings either arranged by or taken by Camp Get-A-Way. I give this consent and release in consideration of and with full knowledge that use of these photographs and videotape and information about me will be in the interest of advancement of Camp Get-A-Way.

Printed Name: {name}
Date of Birth: {date}