DK Hvostik Camp Child Participation Form 2026

St. George Pathfinders Western American Region

Druzhina Kiev Hvostik Camp Child Participation Form
Camp Dates: Hvostik camp will be held from Friday, July 17 to Sunday, July 19, 2026. You're welcome to stay through Monday, July 20th as camp guests for morning liturgy.

Стоимость Лагеря Хвостиков / Cost of Hvostik Camp
- $100 за пару хвостик + родитель / $100 per child/parent pair (July 17-19)
- $125 за пару хвостик + родитель / $125 per child/parent pair (July 17-20)
- $25 за день за второй родитель если один ребенок / $25 per day for second parent in case of single child
Camp Registration: Registration for camp ends on Friday, June 19th.

To be fully registered, complete both steps by June 19, 2026:
1. Fill out, sign and submit your hvostik camp registration form for each hvostik camp participant (children and parents). You'll receive a completed copy of the form in your email.
2. Submit payment.
Payment Information:
1. Payment via credit card may be made online.
2. Payment via Zelle may be made to: kievdruzhina@gmail.com
3. Make checks payable to “St. George Pathfinders” and send to: St. George Pathfinders, c/o Ann Kutner, 2970 22nd Avenue, San Francisco, CA 94132
Spasibo! Thank you for supporting our scouting organization!
Child's Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Dates of Stay:
Parent/Guardian Name:

First NameLast Name
Relationship:

Other
Parent/Guardian Email 1:
Alternate Email 2:
Phone Number 1:

Area CodePhone Number
Alternate Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Name of medical insurance company for above named child:
Policy number:
Child is known to be allergic to the following foods and medications. Additionally, special attention should be paid to the following medical problem: (e.g. other allergies, fainting, diabetes, heart disease, enuresis (bed-wetting), epilepsy, etc.):
Enter N/A if the child has no allergies.
Tetanus shot in effect:

MonthDayYear
Date
PARENTAL RELEASE & CONSENT FOR MEDICAL AND SURGICAL CARE

I/We hereby give consent for Child’s Name: {childsName} Date of Birth: {dateOf} to participate in Hvostik Summer Camp conducted by the St. George Pathfinders.

I/We agree to direct our child to cooperate and conform to directions and instructions of the supervisory personnel in charge of the program. Furthermore, the undersigned agrees to hold the St. George Pathfinders, their officers and all individuals (volunteer adults or other scout campers) placed in charge harmless of any claims that may arise against them from bodily injury or property damage due to accidents or occurrences arising out of my/our child's participation and/or travel in the course of said program whether the result of negligence or any other cause. Rules for acceptance and participation in the program are the same for everyone without regard to race, color, or national origin.

By signing below, I/we hereby give permission for child named above to receive from camp staff over-the-counter medications (i.e., aspirin, Tylenol, topical ointment, etc.) and/or medical or surgical treatment and to be hospitalized if necessary in case of injury or possible illness while participating in the St. George Pathfinders camp.

It is further recognized and agreed that the St. George Pathfinders, their officers and individuals placed in charge will not be liable in any way for accidents, injury or other mishaps whether the result of negligence or other cause.

IT IS UNDERSTOOD THAT IN CASE OF EMERGENCY EVERY EFFORT WILL BE MADE TO CONTACT US OR THE PERSON LISTED IN THE FORM.

SIGNATURE SIGNIFIES CONSENT/AUTHORIZATION THROUGH 8/31/2026 UNLESS OTHERWISE SPECIFIED. TO BE SIGNED BY PARENT OR GUARDIAN.
Signature of Legal Parent or Guardian:
Date of Signature:

MonthDayYear
PARENTAL RELEASE & CONSENT FOR MEDIA

By submitting my camp registration / or as parent or guardian of my child, I acknowledge the use of photographs/media taken during events or activities for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources).

SIGNATURE SIGNIFIES CONSENT/AUTHORIZATION THROUGH 8/31/2026 UNLESS OTHERWISE SPECIFIED. TO BE SIGNED BY PARENT OR GUARDIAN.
Signature of Legal Parent or Guardian:
Date of Signature:

MonthDayYear
Date
Child's Photo:

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Upload current photo of child (passport or school photo) Cancelof
Front side of child's medical insurance card:

Browse Files

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Back side of child's medical insurance card:

Browse Files

Cancelof
Should be Empty:

St. George Pathfinders Western American Region