TCNJ/Beestera Camp - HEALTH & RELEASE FORM
(You will not be admitted to camp without these forms, completed and signed on all pages.)
Camper First Name
*
First Name
Camper Last Name
*
Last Name
Camp Location
*
Camp Start Date
*
Camp End Date
*
Assigned Sex:
*
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Weight (lbs)
*
Height
*
Parent/Guardian Name
*
Relationship to Camper
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact
Please list someone other than the guardian
Contact Name
*
First Last
Phone #
*
Format: (000) 000-0000.
HEALTH & GENERAL HISTORY
Please note any physical restrictions the camper may have during the camp day:
Please list any allergies the camper has and the reaction:
If the camper will be taking medication during camp, please indicate name of drug(s) and dosage:
Please identify any medical condition or medical history that would require special attention:
If the camper needs sunscreen, do you permit camp staff to provide it and, if needed, help apply it?
*
YES
NO
I grant permission for my child to be photographed and/or recorded during Beestera Soccer activities. I understand these images or videos may be used for promotional purposes including social media, website content, and marketing materials.
*
Please Initial in the box
I hereby certify that the named camper is in good health and fully able to participate in all activities of the Sports Camp and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a program:
Parent/Guardian Signature:
*
Date:
*
-
Month
-
Day
Year
Date
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