Lafourche Parish Libraries STEM Summer Camp Registration

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by BayouSTEM, Lafourche Parish Libraries, and Fletcher Technical Community College during the selected camp. In exchange for the acceptance of said child’s candidacy by  BayouSTEM, Lafourche Parish Libraries, and Fletcher Technical Community College, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless BayouSTEM, Lafourche Parish Libraries, and Fletcher Technical Community College and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against BayouSTEM, Lafourche Parish Libraries, and Fletcher Technical Community College including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities, including STEM Camp. 

Medical Release and Authorization

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to BayouSTEM, Lafourche Parish Libraries, and Fletcher Technical Community College and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Disruptive Behavior and Camp Attendance:

Disruptive behavior that prevents other campers from enjoying their experiences during their camp time will not be tolerated. Campers exhibiting disruptive behaviors will get a verbal warning during camp, and parents will be contacted at the end of the camp day.  Additional disruptions after verbal warning will result in child being dismissed from camp for the day. Further disruptive behavior will result in child being expelled from camp for the remainder of the camp week.

Immediate dismissal/expulsion from camp will occur if your child threatens violence or harm to another child/camper, camp staff, or others during summer camp, or if your child physically harms anyone during camp. Campers dismissed for violent acts or threats will not be allowed to attend any other camps we provide for the remainder of the summer.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.