Summer Camp Activity Waiver Form

Summer Camp Activity Waiver Form
This year we have designed a summer camp where children can learn while having fun and develop their skills!
Name of the Child*

First NameLast Name
Name of the Parent/Guardian*

First NameLast Name
Parent/Guardian's Phone Number
Parent/Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which program did you sign up for?*

Week One, That Happened HereWeek Two, Amazing World of AnimalsWeek Three, Water, Water EverywhereWeek Four, Wild, Wild, WildernessWeek Five, All that GlittersWeek Six, Say Cheese
Does your child have any allergies? (please specify)
Note to Parents:
- Campers are encouraged to bring their own water bottles. Please label them with your child's name.
- Campers will be in and out all day. Please dress them accordingly. On occasion campers will get wet. Instructors will notify you ahead of time when water activities are planned. Feel free to send a change of clothes on these days.
- This is an art camp and adventure camp please do not wear "good stuff" to camp.
- Camp will have some sunblock but we encourage you to send some with your children on days they might need it.
- A small (light) breakfast snack will be provided in the morning and a full lunch at noon. If your child needs more than this feel free to send a snack.
- Please be prompt when dropping off and picking campers up. Drop off and Pick up location will be at the back of the Village in the Chapel parking lot. An instructor will be their. If an instructor is not present olease wait until one arrives to leave your child.
- A portion of Camp includes the pledge of Allegiance and the Lords Prayer. If you do not feel comfortable with either of these activities please notify the instructor and they will have your child step out during this portion of the morning activities.
- The Camp instructor will provide their contact phone number for you on the first day of camp.
Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the summer camp activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to the child without the fault of the camp management and activity supervisors, the camp management cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.
Parent/Guardian Signature*

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