Please upload the following photos. We are unable to process paychecks without two forms of ID on file. If you do not have these aviailble when completing the form, please email photos ASAP to MtKids@Mtkids.org, so they may be added to your file.

Please add your favorite funny photo if you need to email photos of the documents later, or if you are too young to have the items required. 

2026 Staff Health Form

Medical Release and Authorization

As Parent and/or Guardian of the named junior counselor, or as the person named as a counselor/staff person, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of myself or 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 athlete. 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 Mountain Kids, Inc . and its affiliates including Directors, Staff, Volunteers, and other representatives of the organization, to provide the needed emergency treatment prior to 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 myself or the named minor child, in my absence.

I agree that if my dependent or I (heretofore known as "we") engage in any physical activity, class, or activity, or facility on the premises or any venue where we participate as a representative of Mountain Kids Incorporated, we do so at our own risk. I agree that we are voluntarily participating in activites and use of said facilities, premises (including the parking lot) and designated Mountain Kids Incorporated venues. We assume all risk of injury, illness, damage, or loss to us or our personal property that might result, including, without limitation, any loss or theft of any personal property. I agree that this consent and assumption of risk statement covers each and every event or activity sponsored by Mountain Kids, Incorporated. I agree to release and discharge you (and your affiliates, employees, assistants, volunteers, agents, representatives, successors, and assigns) from any and all claims or cause of action (known or unknown) arising out of your negligence. I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability. I am waiving any right that I may have to bring legal action to assert a claim against you for negligence.

CONFIRMATION of MEDICAL RELEASE AND AUTHORIZATION

I confirmn the health history provided is correct and accurately reflects the health status of the camper to whom it pertains.  The person described has permission to participate in all camp activities except as noted by me/or an examining physician.  I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to my camper's health for both routine health care and emergency situations.  If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this camper.  I understand the information on this form will be shared with camp staff on a "need to know" basis.  I give permission to photocopy this form.  In addition, the camp has permission to obtain a copy of my or my junior counselor's health record from providers who treat me or my minor, and these providers may talk with the program's staff about my or my child's health status.

BY ACKNOLWEDGING 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.