Participant's Name *

First Name

Last Name

Participant's Date of Birth *

MM

DD

YYYY

Participant's Current Grade

9th

10th

11th

12th

other

Participant's Dietary Needs/Preferences *

We want everyone to feel happy and well-fed, AND ALSO, please make it as easy on us as possible, only choosing what is necessary for your well-being, thanks!

None (anything goes)

Vegetarian

Vegan

Gluten-Free

Dairy Free

Other

Guardian 1 *

First Name

Last Name

Guardian 1 Phone *

(###)

###

####

Guardian 1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian 2

First Name

Last Name

Guardian 2 Phone

(###)

###

####

Guardian 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

In case of emergency, if guardian(s) cannot be reached, please contact:

First Name

Last Name

Emergency Phone *

(###)

###

####

I give permission for my child to be given emergency medical treatment if no parent or guardian can be reached *

I consent

Medical Treatment Release *

If the participant becomes gravely ill or involved in an accident, I authorize a Director of the conference or any other adult staff member to act on my behalf should a guardian or emergency contact not be available upon attempted contact. They may approve whatever non-emergency or emergency treatment is necessary and are authorized to sign any medical release or required form on my behalf. As soon as practicable, I will be contacted in case of an emergency. I also agree to pay any necessary expenses incurred in the medical treatment of my child including, but not limited to, all transportation costs to and from a medical facility, and if necessary, transportation to my home or medical facility of choice.

Liability Release *

All acts or omissions of the chaperones shall not be considered acts or omissions of Adventure Camps. I hereby release Adventure Camps, as well as the Adventure Camps staff from any liability. Under no circumstances will I seek to hold the staff, Adventure Camps, or accompanying adults liable for any injury, accident, or incident affecting the well-being of my child.

Damage and Injury *

If the participant breaks or damages any property as a result of their direct or indirect behavior, I hereby agree to pay for its repair or replacement. I also expect to be contacted immediately if my child’s behavior is such that it could possibly cause injury to themselves and others, or threatens to disrupt the trip so that it cannot continue. If such behavior continues after I speak with my child, I agree to pay all costs associated with the immediate return of my child to their home.

I agree to discuss the above paragraph with the participant prior to the conference *

I Agree

General Release *

Adventure Camps, its Board of Directors, contractors, and all of its employees, acting officially or otherwise, are hereby released from any and all claims, demands, actions, or causes of action, on account of any injury to my child that may occur subsequent to any unauthorized departure from the conference or traveling group, or the presence of the chaperons. This release binds my heirs, executors, administrators, or assigns.

*

I authorize Adventure Camps to utilize my child’s photographic images without identification in its brochures and advertisements in any media, including Adventure Camp’s website. In giving my consent, I hereby release and hold harmless Adventure Camps its agents from any and all responsibility or liability relating to the use of the photographs. I understand that we will not receive compensation should any photograph authorized hereunder be used. (We upload photo albums to the adventure camps website and will not include photos of your child if you do not consent).

I do not authorize Adventure Camps to utilize my child’s photographic images. (Your child will not appear in group photos)