Shirt Size   XS   S   M   L   XL   XXL   

Sneaker Size   Shoe Size   

Shirt Size   XS   S   M   L   XL   XXL   

1. Emergency Contact & Medical Consent Form
Emergency Contact Name (Other than Parent):   First Name   Last Name
Relationship to Child:   Relationship to Child      
Phone number Area Code   Phone Number   

2. Allergies/Medical Conditions:   Share any Allergies or medical conditions   

Current Medications:   Current Medication   

In the event of a medical emergency, I authorize the camp staff to seek emergency medical treatment and to act in the best interest of my child.
Parent/Guardian Signature:   Signature   
Date:   Date   

3. Liability Waiver
I understand that while all reasonable precautions will be taken, there are inherent risks in physical and hands-on STEM activities. I agree not to hold Daley Smith STEM, its staff, or any affiliated entities liable for any injuries or accidents that may occur.
Signature   

4. Media Release Form
I grant permission for photos, videos, or audio recordings of my child taken during the camp to be used for promotional, marketing, or educational purposes.
Yes    No      

5. Code of Conduct Agreement
I acknowledge that my child is expected to wear a Daley Smith STEM Camp Tee each day to camp, will follow the camp rules, respect staff and other participants, and
behave in a way that ensures a safe and fun experience for all.   
Signature