Camp Courage form (includes CFC Waiver)

Camper Name*
Parent Name*
Address*
City*
State*
Zip*
Parent Phone*
Parent Cell Phone*
Parent Email*
Camper Gender*
Camper Date of Birth*

MonthDayYear
Date
Camper Shirt Size*
How did you hear about Camp Courage?*
How has your child's life been affected by cancer?*
YesNo
Does your child have any special needs? If yes, please explain:
Does your child have any allergies? If yes, please explain:
Does your child have any dietary restrictions? If yes, please explain:
Cancer Family Care Waiver/Permission Form
In consideration of my signing this agreement, I hereby assume all risks which might be associated with “Camp Courage” for myself, my heirs, and administrators. I waive any and all rights and claims for injuries or damages which I may have against the organizers and sponsors of this event, Cancer Family Care, Camp Joy Education Center, their representatives and successors for any and all injuries or damages of any kind whatsoever suffered by me or my child as a result of participating in “Camp Courage” and its related activities. I give my permission to administer prescription medications, first aid, emergency transportation, and/or medical treatment to my child.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
I give my permission to Cancer Family Care and the news media to use pictures and/or video of my child enjoying Camp Courage.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Cancer Family Care Waiver/Permission Form