Middle School Leadership Camp Registration 2025

Middle School Leadership Camp Registration

July 30 - August 1, 2025
Hands4Hope Middle School Leadership Camp is for Hands4Hope Youth Leaders entering 6th to 8th grades who were elected or appointed to a Hands4Hope leadership position for the 2025/26 school year. Middle school leadership development participants are invited to engage in this fun-filled 3-day team building and leadership development camp.

Thank you for entering the REGISTRATION portal for Hands4Hope Middle School Leadership Camp. Please see the website for additional steps to complete the process.

Main Middle School Camp Info Page

NO YOUTH MAY ATTEND CAMP UNLESS THE PARENT/GUARDIAN HAS COMPLETED ALL REGISTRATION, PERMISSION, MEDICAL, & RELEASE PAPERWORK

Leadership Camp Permission Form
Participant's Name*

First NameLast Name
T-shirt size*

Adult SmallAdult MediumAdult LargeAdult XLAdult XXL
Select the Hands4Hope staff mentor with whom you work most closely*

Nicole CraineSydnie WarnerLori WhittleMelissa PlacekKate Barba
Emergency Information

Please enter information that you would want us to use in the event of an emergency over the camp time period, July 30 to August 1, 2025.
Parent / Guardian Phone*

Primary Phone NumberAlternate Parent Phone Number
Alternate Emergency Contact Name if parent/guardian cannot be reached*

First and Last NameRelationship
Participant's Physician's Name*
Participant's Physician's Phone #*
Participant's Medical Insurance Name (Kaiser, etc)*
Participant's Medical Insurance Policy Number*
List any important medical/allergy information including any limitation to or on medical treatment rendered to your child. If none, please write "none".*
Please describe any dietary restrictions. If none, please write "none".*
Medications

Medications, including Over the Counter (OTC) medications, can only be administered by your child under the supervision of designated trained Hands4Hope personnel. OTC medications include, but are not limited to: vitamins and supplements, allergy remedies (Benadryl, etc.), cold remedies, aspirin, non-aspirin substitutes, and poison oak remedies. Note that Hands4Hope does not stock or provide any OTC medications.

If your child will need prescription or OTC medication, they must be packaged in pharmacy-prepared containers for prescription medication, or original manufacturer packagaging for OTC medication, and given directly to Hands4Hope personnel at the time of check-in at Leadership Camp. Please ensure that all medications are not past expiration dates.

Medication labels must include:
- Participant name (write on if OTC)
- Name of medication
- Dose of medication
- Method of administration
- Time of administration
Will the participant bring an inhaler or EpiPen? If yes, please specify for what reason. These items must always be carried by the participant.*

NOYes, Inhaler. Participant is competent to safely self-administer medication.Yes, EpiPen. Participant is competent to safely self-administer medication.
If the participant is bringing an inhaler or EpiPen, please explain the reason below.
E.g. asthma, bee sting allergy, peanut allergy, etc.

List all medications that will be brought to camp, including any over-the-counter medications. If additional space is needed, please list in an email and send to lori@hands4hopeyouth.org.

	Medication name	Dose	Frequency	Reason
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6

Permission

The aforementioned named child ("PARTICIPANT NAME") has my permission at attend the Hands4Hope Leadership Camp on July 30 to August 1, 2025.

Medication Permission

The parent or legal guardian’s signature on this form indicates permission to designated Hands4Hope staff to administer the above listed medication(s) to the child or to assist the child to self-administer if applicable.

Emergency Release

In the event of an accident or emergency, when a parent/guardian is unavailable, I hereby authorize a representative of Hands4Hope to make such arrangements as he/she considers necessary for my child to receive medical/hospital care, including necessary transportation. Under such circumstances, I further authorize the physician named in this form to undertake such care and treatment of my child as he/she considers necessary. In the event said physician is not available at any time, I authorize such care and treatment to be performed by any licensed physician or surgeon. THE UNDERSIGNED PARENT/GUARDIAN FULLY UNDERSTANDS HE/SHE IS RESPONSIBLE TO PAY ALL COSTS INCURRED AS A RESULT OF THE FOREGOING.
Liability and Hold Harmless

As a condition for my child to participate in the Hands4Hope Leadership Camp (the Event), to be held July 30 to August 1, 2025, I agree to release Hands4Hope, Staff, and all other parties concerned from any liability for bodily injury, personal injury, theft or damage to my property.

IN CONSIDERATION OF my child being permitted to participate in the Event, the undersigned, on behalf of myself, my heirs, executors, administrators and assigns, hereby:
1. Acknowledges that the undersigned's participation in the Event may include activities that may be hazardous to the undersigned and assumes the risk of injury or harm associated with such participation.
2. Releases and forever discharges the Hands4Hope and its employees, officers, directors, shareholders, affiliates, agents, representatives, successors and assigns (collectively the "Releases") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to myself, my child, or property howsoever caused, arising or to arise by reason of or during my participation in the Event, whether prior to, during or subsequent to my attendance and notwithstanding that any Claim may have been contributed to or occasioned by the negligence of any of the Releases.
3. Indemnifies and saves harmless the Released from and against any and all liability incurred by any or all of them arising as a result of or in any way connected to my participation in the Event.
4. Understands and acknowledges that Hands4Hope does not carry or maintain health, medical or disability insurance coverage for the undersigned and therefore agrees to assume responsibility for such insurance coverage on the undersigned.
5. Agrees that in the event that any provision of this Release and Indemnity is held to be invalid or unenforceable by any court of competent jurisdiction, the invalidity or unenforceability of such provision will not affect the remaining provisions of this Release and Indemnity which shall continue to be enforceable.
Photo/Video Release

In addition, I agree to permit the free use of my child’s name, photograph, and video taken for the purpose of publicity and/or promotion of Hands4Hope. For online promotions, last names will not be used and your personal information is never shared with third parties.

I HEREBY ACKNOWLEDGE READING, UNDERSTANDING AND AGREEING WITH THE FOREGOING.
Electronic Signature Consent

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Indicate below that you have read and understood all of the above signature elements.*

MedicationPermissionEmergency ReleaseLiability and Hold HarmlessPhoto releaseElectronic Signature Consent
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Parent / Guardian Printed Name*

First NameLast Name
Enter your email to receive a copy of these forms.*
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Middle School Leadership Camp Registration

Leadership Camp Permission Form