2026 Florida Sheriff Youth Ranches Participant Release Form

Please complete the following information required by the camp (Florida Sheriffs Youth Ranches) that we stay at for the week...
Florida Sheriffs Youth Ranches

Camp Informed Consent/Medical Information/Photo Release
I understand that my participation in programs with the Florida Sheriffs Youth Ranches, Inc. is entirely voluntary. I release Florida Sheriffs Youth Ranches, Inc., it's employees, staff, and other agents from any claims or liability arising out of my participation. I am not under the influence of any chemical substance including alcohol. I understand that any physical activity involves the risk of increased heart rate and/or injury.
Student Name
Student Phone
Format: (000) 000-0000.
Address

Address

Street Address Line 2

City STState / Province

Zip
Name of Personal Physician
Physician Phone
Format: (000) 000-0000.
Name of Emergency Contact
Emergency Contact Phone
Format: (000) 000-0000.
Do you have health/accident insurance:
If yes, please list carrier/policy number
Do you have any limiting physical or health disabilities or handicaps (temporary or permanent)?
If yes please explain
Are you taking any medications prescribed or otherwise? If so list medication and condition?
List any known allergies to medications or otherwise:
If you are allergic to insect bites/stings, do you have appropriate medication?
Do you wear contact lenses/glasses?
Are you pregnant?
Do you currently have any of the following symptoms or conditions (check if yes):
If you checked any of the above, please explain each:
Have you had any recent injuries? Please explain:
List any other conditions we should be aware of
I hereby consent to and authorize the use and reproduction by the Florida Sheriffs Youth Ranches, Inc. of any photographs, video, and sound recordings taken of me during this program for any media or marketing use.
Mark no if you do not agree to the above statement:
Participant
Date

MonthDayYear
Date
Parent/Guardian Name:
Date

MonthDayYear
Date
Parent/Guardian Signature (if participant is under 18 - if over 18 then participant may sign):
Should be Empty:

Please complete the following information required by the camp (Florida Sheriffs Youth Ranches) that we stay at for the week...