2026 FP APPLICATION

EMERGENCY INFORMATION
PEDIATRICIAN*

First NameLast Name
PHONE NUMBER*
Please enter a valid phone number.
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
INSURANCE COMPANY*
INSURANCE ID NUMBER*
EMERGENCY CONTACTS

Contacted for emergency, illness, pickup if the parents/guardians cannot be reached.
Contact #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Contact #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.

MEDICAL RELEASE
In the event of an emergency I understand that the school will call me. I give my consent for trained staff to administer first aid or call 911 and have my child transported to the nearest medical facility.

Parents give permission to inform necessary camp staff of any medical needs their child may have.
Child #1*

First NameLast Name
Child #2

First NameLast Name
Name of Parent or Guardian*

First NameLast Name
Signature of parent or Guardian*

Clear

Insect Repellent Consent

Please fill out if applies.
CHILD #1

First NameLast Name
CHILD #2

First NameLast Name
SESSION(S) ATTENDING

Session #1Session #2Session #1 & 2
TICKS
It is almost impossible to determine where you picked up a tick as they are prevalent throughout the state of NY. Blue Rock School regularly has the grounds cedar oil sprayed to minimize exposure to ticks. However, evening tick check rituals should be part of every family’s routine through the duration of the Forest Play Program. Parents should consider applying bug spray before sending their child to Forest Play.

Children with a signed consent will be assisted by teachers to have another layer of insect repellant applied after lunch.Please be sure to mark your child’s name in permanent marker on the container. We will keep the insect repellant in your child’s classroom & send it home if it gets used up.
CONSENT

I give permission for The Forest Play Program staff to assist my child in applying the insect repellent that I will provide as needed.
Name of Parent or Guardian

First NameLast Name
Signature

Clear

Sun Protection and Sunscreen Consent

Please fill out if applies.
CHILD #1

First NameLast Name
CHILD #2

First NameLast Name
SESSION(S) ATTENDING

Session # 1Session# 2Session # 1 & 2
Wearing protective clothing, including a hat with a wide brim can help children stay comfortable in hot temperatures, we will control the intensity and duration of outdoor activities as well as allow for rest periods in shady areas. All children will be encouraged to drink extra water before, during and after outdoor play. Since it is best to apply sunscreen 30-40 minutes before going outside, please be sure to apply a first layer of sunscreen to your child before coming into Forest Play.

Children with a signed consent will be assisted by teachers to have another layer of sunscreen applied after lunch.
Please be sure to mark your child’s name in permanent marker on the container.
We will keep the sunscreen in your child’s classroom & return it when it is used up.
CONSENT

I give permission for The Forest Play Program staff to assist my child in applying the sunscreen that I will provide as needed.
Name of Parent or Guardian

First NameLast Name
Signature of Parent or Guardian

Clear

2026 FOREST PLAY SUMMER PROGRAM