Permission Form

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Permission Form

Bloomingdale Day Camp (BDC) Summer of 2021 Camper Permission Form

Campers First Name *

Campers Last Name *

Parent/Guardian Name & Relationship *

Please review and acknowledge your permission for your camper *

As the parent/guardian of the above named camper, I hereby consent to my child attending summer camp at BDC during the period of June 23, 2021 through August 20, 2021 as registered. I also grant permission for my child to participate in off camp trips when included as part of their described program using such means of transportation as deemed necessary by BDC. I understand that this program includes active games, sports, outdoor pursuits and swimming. I will not hold the Bloomingdale Day Camp or any other person involved in the program to be liable for anything not covered by Bloomingdale Insurance. Also, the Bloomingdale Board of Education, School Personnel, or property will not be liable for such misfortunes, accidents or otherwise. I further agree that my child or ward must comply with the rules of the activity and that any violation may result in his or her expulsion from the program. I ALSO REALIZE AND AGREE THAT I AM LIABLE FOR ANY DAMAGE CAUSED BY MY CHILD.

I hereby consent to the taking of photographs, movie or video clips of my child by Bloomingdale Day Camp or it's designated representatives in connection with fundraising materials, promotional brochures or videos, including end of year slide show. I also grant the right to edit, use and re-use said products for any and all educational, public service or not for profit purposes selected by Bloomingdale Day Camp for pictures, reproductions, copies or negatives of the same in connection with such uses. Photo copies and facsimiles of this release and consent shall have the same legal effects as the original. A authorize any photographs, movies or video clips to be placed on the Bloomingdale Borough's Website, Bloomingdale Recreation's Website or published to Facebook promote Bloomingdale Day Camp.

I give permission for BDC to administer any prescription medication to my child while in the care of camp as provided to camp. I understand that camp will make every reasonable effort to notify the parent/legal guardian or the emergency contact identified in the event of a campers illness or injury or other medical condition, however, I authorize camp personnel to seek appropriate care or treatment, and for any care or treatment to be administered in the event that I or the emergency contact cannot be contacted. I hereby consent to the administration of such anesthetics and the performance of such surgery or treatment as deemed necessary or advisable while my child is in any medical facility or hospital. I further consent to administration of tetanus anti-toxin to said camper if necessary.

I consent for my child to use sunscreen that he/she has brought or that camp has supplied, which is approved by the FDA for over the counter use to avoid overexposure to the sun. My child may be assisted by unlicensed camp staff if he/she requests assistance.

I have read and understand the Borough of Bloomingdale Day Camp Zero Tolerance Policy and agree to it's provisions requirements and penalties.

I have read and understand the Bloomingdale Day Camp Refund Policy and agree to it's provisions and requirements.

Required

Electronic Signature: (type your name below and indicate date) *

Rev. 3 4/21

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