Health and Consent Form

Health and Consent Form
Name

Camper's First NameCamper’s Last Name
Birthdate

MonthDayYear
Date
Gender

MaleFemaleOther
Parent/Guardian

First NameLast Name
Tshirt Size
Frequently checked Email:
Phone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Sibling with Diagnosis Name
Birthdate

MonthDayYear
Date
Gender

MaleFemaleOther
Diagnosis

Sib Camp Participant Health Form
Camper Name
Emergency Contact
Emergency Phone
Physician
Physician phone
Height
Weight
MEDICATIONS

Medications prescribed by a doctor are to be given by an adult camp counselor during tSib Camp and must be in their original containers, with current dates, specific administration directions, and the doctor’s name. Other medications such as inhalers, creams, ointments, and other solutions should also be properly labeled so medications are given correctly. All medication containers will be placed in Ziplock type bags on arrival and the same will be returned to parents. Please lists all medications (prescription or over the counter) with name, dosage, when to take and other necessary instructions.
List Medications Currently Taken
List name, dosage, times taken and any other medication instructions.
Date of most recent Tetanus Booster

MonthDayYear
Date
Do you currently have any of the following medical conditions? Check If yes.

AsthmaCurrent bone breaksCurrent sprainsDiabetesFood allergyHeart conditionAnxietyOther
Allergies
Briefly explain any other conditions that are checked

Camp Permissions and Acknowledgements
Camp Expectations Acknowledgments

By signing and submitting this form, I confirm that I have reviewed the Sib Camp 2025 Rules and Expectations document with my child. We understand and agree to follow the guidelines outlined, including behavioral expectations, the zero-tolerance policy, and the camp’s cell phone and electronics policy. We acknowledge that failure to adhere to these expectations may result in early dismissal from camp.
Parent/Guardian Signature

Clear
SIB CAMP CONSENT FOR FILMING, SOUND RECORDING OR PHOTOGRAPHING

I, {parentguardian}, consent to videotaping, photographing, sound recording, or news coverage of, {name}, for the purpose of community education and awarness. I understand these images or videos may be used on WisconSibs social media. This consent applies only to recording data during the duration of Sib Camp 2025
I agree to the following media recordings:

Videotapingsound recordingphotographingnews coverage
Signature of authorized parent/guardian

Clear
Payment and Deposit Acknowledgment

By signing and submitting this form, I acknowledge that full payment for Sib Camp 2025 or county funding authorization must be received no later than June 27, 2025. I understand that a $100 deposit is required to secure my child’s registration. If my child does not attend camp and I do not notify WisconSibs in advance (no call, no show), I forfeit this deposit regardless of funding source or cancellation reason.
If I am using county funding, I understand that my deposit will only be refunded once county authorization is verified and my child attends camp.
Parent/Guardian Signature

Clear
Agreement of Risk and Responsibility

By signing and submitting this form, I, {parentguardian}, grant permission for my child to attend Sib Camp 2025 at Daycholah Center, and I acknowledge that I have reviewed the camp’s rules and expectations with my child. We understand that safety begins with each participant and that my child is expected to follow all safety rules and instructions provided by WisconSibs staff and camp counselors, and to communicate with staff if they are ever unsure about their ability to safely participate in any activity.

I understand that some camp activities may involve physical exertion and outdoor elements. Participation is voluntary, and I affirm that my child is physically able to engage in the activities offered.

I have provided complete, accurate, and up-to-date health information for my child and will notify WisconSibs staff of any changes in health or fitness prior to camp. I understand that first aid will be available on site and that my child will be closely supervised. In the event of a serious illness or injury, I give permission for WisconSibs staff to administer first aid and to secure emergency medical or hospital care as recommended by the attending physician. I understand that every effort will be made to contact me in such an event.

Furthermore, I understand and accept the risks associated with camp participation and agree not to hold WisconSibs, Inc. or Daycholah Center, their staff, volunteers, or affiliates responsible or liable for any personal injury, illness, or accident that may occur while my child is attending camp.
Signature of Parent/Guardian

Clear
Should be Empty:

Health and Consent Form

Sib Camp Participant Health Form

Camp Permissions and Acknowledgements