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  • Permission and Medical Release Form

  • Electronic Signatures. The parties acknowledge and agree that this permission and medical release form may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. Without limitation, “electronic signature” shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature.

  • Participant Information

  • Type of Registration*
  • Ward
  • Is this your first year of camp?
  •  -
  • DOB
     - -

  • Parent/Emergency Contact Information

  •  -
  •  -

  • Medical Information

  • Does the participant require a special diet?*
  • Does the participant have any allergies?*
  • Is the participant taking any medication or over-the-counter (OTC) drugs?*
  • Can the participant self-administer his or her medication?

  • Physical Conditions that limit activity

  • Does the participant have a chronic or recurring illness?*
  • Has the participant had surgery or a serious illness in the past year?*

  • Conduct at Church Activities


    Church events and activities can be fun, uplifting, and spiritually strengthening for everyone who attends. To reach these aims, all participants are invited to commit to follow the principles taught in For the Strength of Youth: A Guide for Making Choices. When you do, the experience will be better for everyone.
    Please note that Church activities are not the time or place for romantic behavior or for conversations and actions that distract from the purpose of the event or activity.


    If you participate in any of the following prohibited activities, leaders at the event or activity will speak with you, your parents, and your bishop or stake president. These leaders may decide to send you home immediately.

    •  Participating in or encouraging immoral behavior of any kind, which includes
      breaking the law of chastity or viewing or distributing pornography in any form
    • Shoplifting, theft, or vandalism of any kind
    • Breaking the Word of Wisdom, including vaping and possessing illegal or harmful substances
    • Possessing weapons or dangerous items of any kind (if specifically authorized,
      certain items may be provided and used in supervised activities)
    • Harming or threatening to harm yourself or others physically, spiritually, or emotionally, including bullying in any form or disrupting another’s experience
    • Leaving without following proper procedures, skipping scheduled activities
      without permission, or breaking curfew

    Crimes and harmful or destructive incidents or pranks may be reported to local
    authorities, who will respond according to local law. Leaders follow the direction of these authorities.

  • Signature

    I give permission for my child/youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event. The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp, or event safety rules and other pertinent instructions. Participants’ conduct and interactions should abide by Church standards and exemplify Christlike behavior. Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if they behave inappropriately or if they pose a risk to themselves or others.
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