Summer Camp Permission to Participate in Activities: Challenge, Inc.
Participant's Full Name*
First Name Last Name
Participant's Birth Date*
Month Day Year
Parish/School*
Email
example@example.com
Grade Completed*
Child's Allergies or medical problems
Participant's blood type:
Tshirt Size
Nature and Duration of Activities*
1. Activity Supervisors
Consecrated college-aged volunteers.
2. Transportation
Participants are responsible for securing their own rides to and from Lorem Ipsum.
3. Mentoring
Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).
4. Requirements
The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above.
5. Consent
I hereby attest that I am (we are) the legal parentguardian(s) of the above-named child and hereby consent to the child's participation in the activities described above. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.
6. Insurance
I/We understand that Challenge,Inc. does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.
7. Emergencies
If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).
8. Release and Identification
I release and waive, and further agree to indemnify, hold harmless or reimburse Challenge,Inc., the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.
Parent/ Guardian Full Name*
First Name Last Name
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Mom's E-mail*
Dad's E-mail*
Home Phone Number
Area Code Phone Number
Mom's Cell Phone Number*
Area Code Phone Number
Dad's Cell Phone Number*
Area Code Phone Number
9. Emergency Contacts
If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
Emergency Contact#1 Name*
First Name Last Name
Relationship*
E-mail*
Home Phone Number
Area Code Phone Number
Cell Phone Number*
Area Code Phone Number
Emergency Contact#2 Name
First Name Last Name
Relationship
E-mail
Home Phone Number
Area Code Phone Number
Cell Phone Number
Area Code Phone Number
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.*
I agree
Date*
Month Day Year
Are you interested in volunteering as a chaperone and/or provide transportation to nearby park?If so, please check which days you are available:
Sunday afternoon 2pm to Monday 12 noon Monday 12 noon to Tuesday 12 noon Tuesday 12 noon to Wednesday 12 noon Wednesday 12 noon to Thursday 12 noon
Signature
Clear
Should be Empty:

Summer Camp Permission to Participate in Activities: Challenge, Inc.

1. Activity Supervisors

2. Transportation

3. Mentoring

4. Requirements

5. Consent

6. Insurance

7. Emergencies

8. Release and Identification

9. Emergency Contacts