2026 SUMMER PROGRAM EMERGENCY INFORMATION FORM

AUTHORIZATION TO PICK-UP

We must have written permission to release your child to anyone other than the legal guardians. This form acts as that, but if someone who is not on this form needs to pick-up your child, please send a note.
Name #1

First NameLast Name
Phone Number #1
Please enter a valid phone number.
Name #2

First NameLast Name
Phone Number #2
Please enter a valid phone number.
Name #3

First NameLast Name
Phone Number #3
Please enter a valid phone number.

AUTHORIZATION TO OBTAIN MEDICAL TREATMENT

In the event that I cannot be reached in an emergency requiring medical attention for the above named child, permission is hereby given for the staff of Seacoast Waldorf School programming who are CPR/first aid certified to administer CPR and/or first aid as deemed necessary. Further permission is given to allow medical services to be performed by doctors, hospitals or other qualified medical providers as deemed necessary in an emergency, including surgery if reasonably necessary. I understand that the cost of all emergency services is my responsibility. In case of an accident or serious illness, I request that the school contact me. If the school is unable to reach me, I hereby authorize the school to provide the emergency care necessary, including transport to a hospital and treatment they deem necessary.
Guardian Signature*

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Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
NOTE: If you have any medical condition that the Seacoast Waldorf School provider should be aware of it is your responsibility to let us know of the existing condition prior to the start of any program. The information will be held in confidence and used only to render assistance should the need arise.
PERMISSION TO PHOTOGRAPH

While at Seacoast Waldorf School, occasionally photos and video-taping will be taken during camp and may be used for Seacoast Waldorf School and publications including its Website and facebook page. However, we will not identify your child by name or release any personal information.
Permission to have child's picture taken*

I do GIVE permission to have my child's picture taken.I do NOT GIVE permission to have my child's picture taken.
Signature*

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Date*

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Date
SUNSCREEN AND BUG SPRAY

Sign here if you want us to reapply sunscreen and bug spray throughout the day as needed (please supply these for your child):
Guardian Signature*

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Date*

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Date
LIABILITY RELEASE WAIVER AND AUTHORIZATION FORM

Participation at a Seacoast Waldorf location exposes participants to certain risks of being outdoors. Accidents and injuries resulting from the forces of mother nature, live animal and bug interactions, slipping and falling, malfunctioning equipment, unseen obstacles, fatigue, and your own and others’ misjudgment are very real possibilities.
AFFIRMATION AND LIABILITY RELEASE

THE UNDERSIGNED CERTIFY THAT THEY AGREE AS FOLLOWS:

1. I hereby affirm that I have been informed that there are inherent dangers of being outdoors at a summer camp.
2. I hereby agree to indemnify and hold harmless this Seacoast Waldorf provider and its owners, volunteers, and workers as well as Seacoast Waldorf Association from any and all liability for any harm, injury, death, or damages (physical, mental, or monetary), regardless of faulty or negligence, which may befall me and/or my child while participating in this program or while using Seacoast Waldorf facilities. This release shall be binding upon my family, heirs, and administrators.
3. I hereby agree to heed at all times the advice and instructions of the Seacoast Waldorf instructors and its owners to practice common sense while at the summer camp.
The above named participant, a minor child has permission to participate in the activities of Seacoast Waldorf programming.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my child’s participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Seacoast Waldorf Association on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Guardian Signature*

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Date*

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Date
Should be Empty:

2026 SUMMER PROGRAM EMERGENCY INFORMATION FORM

GUARDIAN INFORMATION

EMERGENCY CONTACT PERSON

MEDICAL HISTORY

AUTHORIZATION TO PICK-UP

AUTHORIZATION TO OBTAIN MEDICAL TREATMENT

PERMISSION TO PHOTOGRAPH

SUNSCREEN AND BUG SPRAY