Rising Above Boundaries Summer Camp Registration

RAB Summer Camp Registration
Camper's Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
MaleFemale
What grade is the camper entering next school year?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Medical Insurance Information
Insurance Company
Policy Number
Subscriber
Insurance Company Phone Number
Primary Care Physician
Name of Doctor
Phone Number
Does the camper have any allergies, chronic illness, dietary or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Informed Consent & Acknowledgment
I give permission for my child to participate in all activities organized by Rising Above Boundaries during the selected camp session.

I understand that participation in camp activities, including physical play, sports, field trips, and enrichment experiences, involves inherent risks. By enrolling my child, I acknowledge these risks and agree to release and hold harmless Rising Above Boundaries, its directors, staff, volunteers, affiliates, and partnering organizations from liability for injuries that may occur during travel to, participation in, or return from camp activities.

In the event of an injury, I authorize camp staff to seek appropriate medical attention for my child if necessary.

I understand that while safety precautions and supervision are provided at all times, injuries can occur in activities involving movement and physical participation.
Medical Release & Authorization
As the Parent and/or Legal Guardian of the enrolled child, I authorize Rising Above Boundaries and its designated representatives to obtain emergency medical care for my child if I cannot be reached and a medical professional determines that immediate treatment is necessary.

I grant permission to qualified and licensed medical personnel to provide emergency treatment, including medical evaluation, diagnostic testing (such as x-rays), medication, minor medical procedures, or other care deemed necessary to protect my child’s health and safety.

In the event of serious illness or injury requiring significant medical intervention, every reasonable effort will be made to contact me as quickly as possible. This authorization applies only when a reasonable attempt to reach me has been unsuccessful.

I also authorize Rising Above Boundaries staff, including directors and authorized personnel, to provide basic first aid and to secure emergency transportation when needed.

This authorization is effective for the duration of my child’s enrollment in the registered camp session.

I understand that this release is executed voluntarily for the sole purpose of ensuring prompt medical care for my child in emergency circumstances.
Date

MonthDayYear
Date
Should be Empty:

RAB Summer Camp Registration

Camper's Information

Medical Insurance Information

Primary Care Physician