Youth Camp Counseling Liability Release Form
Complete this form to provide camper details, emergency contact information, and acknowledge the youth camp counseling liability release terms. Do not include sensitive health information.
Participant and Guardian Information
Camper Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Guardian Full Name
*
First Name
Last Name
Relationship to Camper
*
Please Select
Parent
Legal Guardian
Grandparent
Sibling
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Camp Attendance and Emergency Contact
Camp session or attendance period
*
Emergency contact name
*
First Name
Middle Name
Last Name
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Special care or participation notes
Liability Release and Authorization
Guardian Signature
*
Submit
Submit
Should be Empty: