Summer Camp Parental Consent Form

Summer Camp Parental Consent Form
Child Name
First NameLast Name
Gender
Child's Information
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Home Phone
Format: 0000-00000.
Emergency Contact Name(if parent or guardian is not avaliable)
First NameLast Name
Emergency Number
Format: 0000-00000.
Emergency Number #2
Format: 0000-00000.
Birth Date
MonthDayYear
Year of Graduation
Grade entering in the fall
Parent or Legal Guardian Information
Parent/Legal Guardian
First NameLast Name
Relation
Work Phone
Format: 0000-00000.
Cell Phone
Format: 0000-00000.
Parent /Legal Guardian 2
First NameLast Name
Relation 2
Work Phone 2
Format: 0000-00000.
Cell Phone 2
Format: 0000-00000.
Email Confirmation
Parents Email (child confirmation will be sent by email, if left blank it will be mailed)
example@example.com
Child's Email
example@example.com
Health Information
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the child should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
List any past medical treatment that would be helpful for us to know.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above-named camper, and are over the age of 18. In case of a medical emergency or general medical care, I give consent for medical treatment for the above-named camper by authorized personnel. I understand that the above-named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activities. I authorize that the camp host may use my child's picture, testimony, and video in any promotional material(web, print, or media).
Signature
Clear
Should be Empty:

Summer Camp Parental Consent Form

Child's Information

Parent or Legal Guardian Information

Email Confirmation

Health Information