Camp Creativity Health & Safety Form

Health & Safety Form

Thank you for enrolling your camper in a summer camp at the Fitton Center for Creative Arts! The next step is to complete our online Camper Health & Safety Form below.
This form must be completed no later than the Friday before your child's camp is scheduled to begin. If you are unable to complete the form at this time, no worries- we also sent a link to the email you provided at checkout!

Please review our updated 2024 Summer Camp Procedures and Protocols by visiting fittoncenter.org/camp-procedures-and-protocols to ensure that both you and your camper(s) are prepared for the first day of camp!
Camper Information
Camper Name*

First NameLast Name
Gender

MaleFemaleOther
Date of Birth*

MonthDayYear
Age*
Home Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Parent/Guardian Information
Parent/Guardian #1 *

First NameLast Name
Relationship to Camper
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Best phone number to reach you during camp hours?
E-mail*
Parent/Guardian #2 or Other Emergency Contact

First NameLast Name
Relationship to Camper
Phone Number

Area CodePhone Number
In addition to parent/guardians, my child may be released ONLY to the following individuals listed below (must be at least 18 years of age):
Please list name, relationship to camper, and phone number for each contact provided:
Special Considerations

Please note: The Fitton Center cannot administer medication of any kind. If children must take medication, staff and instructors cannot be responsible for reminding them of medication administration or times.
Allergies/ Food Sensitivities*

NoneYes
If you selected "Yes" above, please describe.
Medical/Special Concerns

NoneYes
If you selected "Yes" above, please describe.
Required Signatures
The Fitton Center has permission to secure emergency transportation for my child in the event of an injury or illness which requires emergency treatment. The emergency transportation service will determine the facility in which my child will be transported and administration of treatment will be determined by a licensed physician or dentist at this facility. *
I have read, understand, and agree to the Fitton Center for Creative Arts Camp Procedures and Protocols outlined at fittoncenter.org/camp-procedures-and-protocols. *
FITTON CENTER PARTICIPANT WAIVER

Please Read Carefully

BY REGISTERING FOR A CLASS, CAMP OR WORKSHOP held at the Fitton Center for Creative Arts, including any other groups offering classes sponsored by the Fitton Center, you waive and release any and all rights and claims for damages you or your child(ren) may have against the Fitton Center and its representatives, successors and assigns for any and all injuries suffered by you or your child(ren) during any class, workshop, camp or other activity sponsored by the Fitton Center, whether held on its premises or at an outside location.

My child has permission to be PHOTOGRAPHED or VIDEOTAPED for us in conjunction with Fitton Center marketing purposes, including but not limited to private or public presentations, advertising, publicity, and promotions.
I HAVE READ AND UNDERSTAND THE WAIVER AND RELEASE ABOVE.*
Full Name of the above signed*

First NameLast Name
Relationship to child*
Date*

MonthDayYear
Should be Empty:

Health & Safety Form

Camper Information

Parent/Guardian Information

Special Considerations

Required Signatures