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Youth Camp 2021
June 7th-10th
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Student Name
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Address:
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Student Birthday
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Student Current Grade:
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Student Phone Number:
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Parent/Guardian Name:
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Parent Email Address:
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Parent Phone Number:
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Emergency Contact Name/Number/Relationship
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Your answer
Student Allergies/Medications:
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Your answer
Please initial to the following:
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I will allow my child to be treated with over the counter medications for minor illnesses such as headache, diarrhea, etc. (i.e., Tylenol, Pepto-Bismol, Aloe Vera, etc.)
My child has permission to self-medicate according to prescription guidelines for any prescriptions he/she may be taking.
I give my permission for videos or photos containing images of my child to be used for promotional purposes. I acknowledge that fees will not be paid for such use.
I will check my child’s temperature before sending him/her to camp and not allow him/her to attend if not feeling well.
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