Summer Camp Registration Form

Child's Information

First name

Last name

Age and Birthday

Gender/Pronouns (optional)

Home language(s)

Family Information

Parent/Guardian Full Name

Phone Number

Home Address

Parent/Guardian Full Name

Phone Number

Home Address (if different from above)

Emergency Contact Information (if parent/gaurdian is unavailable)

Emergency Contact Full Name

Phone Number

Relationship to Child

Health and Medical Information

Does your child have any allergies? (Food, insect stings, environmental, medication, etc.)

Does your child have any medical conditions? (Asthma, diabetes, epilepsy, etc.)

Does your child have prescribed rescue medication that would need to be left with camp staff? (EpiPen, inhaler, seizure rescue meds, etc. -- If yes, please provide an emergency action plan from your child's doctor)

Does your child have any dietary restrictions? (Vegetarian, gluten-free, etc.)

Medical Insurance Provider & Policy Number (if known)

In the event of an accident or illness, I understand that reasonable efforts will be made to contact the parent/guardian immediately. By signing below, I authorize Spring Forest to secure emergency medical care as needed of I am unavailable.

Signature field is empty.

Additional Information

Is there anything else you would like us to know about your child? (special needs, fears, behavioral concerns, etc)

By signing below, I give permission for photos/videos to be taken of my child and used for promotional purposes by Spring Forest (grants, presentations, newsletters and social media). This is optional.

Signature field is empty.

Liability Waiver

SPRING FOREST ACTIVITIES

STATEMENT OF AUTHORIZATION AND CONSENT

We (“parent” and “child”) understand that participation in the Spring Forest program(s) (“activity” or “activities”) is voluntary and that any program of activity involves some element of risk. We agree that in partial consideration of Spring Forest (“organization”) sponsoring this activity and permitting parents and children to participate, we will not attempt to hold Spring Forest, its officers, agents, and employees liable in damages for any injury or loss to person or property I or my child might sustain while so participating; and we hereby release Spring Forest, its officers, agents, and employees from any liability whatsoever for any personal injury arising from participation in the program/activity. Furthermore, parent or legal guardian covenants that if parent or legal guardian is not present at the activity with their child, they give agency to their child’s teacher or other educational supervisor provided by the child’s school. Such parent, agent of parent, or legal guardian in charge of child shall not leave child unattended at any time while on the property of Spring Forest and each assumes complete responsibility for safety, health, and well-being of child.

RELEASE, ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND HOLD HARMLESS AGREEMENT

PARTICIPATION AGREEMENT

In return for Spring Forest allowing me and/or my child to participate in Spring Forest activities and having read and understood this Participation Agreement, I hereby state that I agree to the following:

A. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Spring Forest, its officers, employees, or agents (hereinafter referred to as RELEASEES) for any liability, claim and/or cause of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or my child that occurs as a result of participation in this activity.
B. I agree to INDEMNIFY AND HOLD HARMLESS the RELEASEES whether injury or damage is caused by my negligence, the negligence of RELEASEES, or the negligence of any third party from any loss, liability, damage or costs, including court costs and attorneys’ fees, that RELEASEES may incur due to participation in this activity.
C. It is my express intent that this RELEASE and HOLD HARMLESS AGREEMENT shall bind the members of my family, if I am or my child is alive, and my heirs, assigns and personal representatives, if I am or my child is deceased.
D. I understand that by participating in this activity I will ASSUME THE RISK of injury for me and my child from risks and damages that are inherent in any activity.

I have read and understood the risks and agree to the terms above (Signature of Parent/Legal Guardian)

Signature field is empty.

Print full name as signed above

Date

Month

Day

Year

I have read and understood the risks and agree to the terms above (Signature of Parent/Legal Guardian 2)

Signature field is empty.

Print full name as signed above

Date

Month

Day

Year

SOUL REVIVAL

Summer Camp Registration Form

Subscribe to Our Site