STARBASE Swamp Fox Summer Camp Registration Form:

*CAMP IS CLOSED FOR REGISTRATION*
STARBASE Swamp Fox Summer Camp Registration Form:
STARBASE Swamp Fox Summer Camp is for dependents of SCMD employees, Army and Air National Guard Personnel, Active Personnel assigned to National Guard Units, and Active Duty Personnel. Camp is limited to the first 25 campers who sign up and qualify in each session. There is no registration fee for the summer camp. You will be notified when your camper is selected for camp. For additional information please contact:

Tierra Woods (Camp Coordinator) at 803-636-5086

Camp Information:

Time: students may be dropped off as early as 7:15 am, but need to be here no later than 8:30 am. Camp will end at 4:30 pm, however all campers must be picked up no later than 5:00 pm.

Address: 1325 South Carolina Road, Stop 39, Eastover, SC 29044

Note: All campers must bring a bag lunch with drink, an afternoon snack, and water bottle.
Parent Information:
Parent/Guardian*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
National Guard/SCMD/Active Associate Sponsor Information:
Sponsor's Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Work Email*
example@example.com
Affliation:*
Camper Information:
Camper #1*

First NameLast Name
Current School:*
Camper's Birthdate:*

MonthDayYear
We collect basic demographic info for reporting purposes only — your privacy is important to us
Camper's Race:*
Camper's Ethnicity:*
Camper's Gender:*
Has your camper participated in STARBASE Swamp Fox Summer Camp before?*

YesNo
Are there any allergies that STARBASE staff needs to be aware of? (Please put N/A if none)*
Camper's Call Sign:*
A call sign is a unique identifier used in military, aviation, amateur radio, and other communication fields to distinguish individuals, units, or aircraft. It can be a combination of letters, numbers, or words and is often assigned for operational security, brevity, or tradition. In military settings, call signs are used for radio communication, while in aviation, they identify aircraft and pilots.
STARBASE Swamp Fox staff's call signs are:
- MJ
- Sway-Zee
- Wonder Woman
- M
- SuSu
Get CREATIVE!!
Emergency Contact Information:
Name:*

First NameLast Name
Relation to Camper:*
Main Phone Number:*
Please enter a valid phone number.
Alternate Phone Number:
Please enter a valid phone number.
Pick Up Authorization:
In addition to the sponsor, I authorize the following individuals to pick my child up from camp:
Name

First NameLast Name
Relation:
Name

First NameLast Name
Relation:
Name

First NameLast Name
Relation:

Release of Liability:
In the event of an accident illness or injury, and the person/s listed as the emergency contact cannot be reached, I hereby give STARBASE Swamp Fox personnel permission to take action as deemed in the best interest of my child.

I hereby grant permission for my child or ward to participate in the STARBASE Swamp Fox Summer Camp and its affiliated activities, including supervised use of teacher selected websites, permission for photography and video taping for promotional purposes. I hereby waive any monetary or other rights that my child or I may have to inspect and/or to approve the finished product of the adverstising copy that may be used in connection with the use to which it may be applied. I hereby consent to the release of said portraits, pictures, videotapes, or motion pictures, to other broadcast media, such as non-governmental television, cable, or radio stations. I further assign to the said organizations all right and title and interest in the aboved described videotapes, publicity pictures etc. I understand and agree that said organizations might maintain video tape recordings, photographs, etc. for training purposes and archives.

I understand this program is an educational experience with hands-on activities, teamwork, and building of self-confidence. This program also entails visits to military work areas around heavy equipment, aircraft, and other military items. There may be field trips and my child may be transported in military and/or civilian vehicles assigned to the STARBASE Swamp Fox program. I take full responsibility for any damage that might occur to government/STARBASE Swamp Fox program property caused by my child. I agree not to hold the US Government, South Carolina Military Department, The South Carolina National Guard, South Carolina STARBASE Swamp Fox Inc., STARBASE sponsoring agencies, and/or its staff or representatives liable in any way for mishaps, which could occur due to the nature of the activity , in which my child is engaged or should injury/death or disability result from participation in STARBASE Swamp Fox Summer Camp. I also understand that the STARBASE Swamp Fox staff reserves the right to terminate the participation of my child when it is deemed to be in the best interest of either the child or the STARBASE Swamp Fox Summer Camp, as determined by the STARBASE Swamp Fox staff.

I, therefore, agree any and all risk for my child to be involved in the STARBASE Swamp Fox Summer Camp and other acitivities related directly or indirectly to it.

I further understand that I may ask any and all questions prior to signing this consent form.
By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions outlined in this Release of Liability. I further certify that I fully understand its contents and agree to be legally bound by its terms.
Signature*

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Date*

MonthDayYear
Date
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*CAMP IS CLOSED FOR REGISTRATION*

STARBASE Swamp Fox Summer Camp Registration Form:

Parent Information:

National Guard/SCMD/Active Associate Sponsor Information:

Camper Information:

Emergency Contact Information:

Pick Up Authorization:

Release of Liability:

CAMP IS CLOSED FOR REGISTRATION