Cedar Point Summer Camp 2024 Parents Consent Form

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Charlotte Harbor Environmental Center

2024 Spring Camp Cedar Point Environmental Park Englewood, Fl

Serving Children ages 8-12

For more information call 941-475-0769

Mail to P.O. Box 512876 Punta Gorda Fl 33951

Or email: Tome@checflorida.org

Email *

Camper's Name *

Emergency Contact Phone Number *

I give permission to transport for medical treatment: Parent/Guardian Initial *

Known Allergies *

Does your child have any medical conditions we should be aware of? *

List persons authorized to pick up your child, along with a phone number. (If there is a change in this information, notify the CHEC office before pick-up date.) *

Parent/Guardian Medical Release: I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the emergency persons listed. In the event they cannot be reached, I give my consent for CHEC staff to act on my behalf in granting permission for my child to be transported and receive emergency treatment. (Parent/Guardian Initials) *

Release from Liability: I understand that all reasonable safety precautions are taken by CHEC in the operations of its facility, equipment and programs. I agree that my child's participation in the CHEC programs shall be undertaken at his/her sole risk, and that CHEC, its directors, employees, and volunteer staff, shall not be liable for any claims, injuries, damages, losses, diseases, wrongful death, actions or causes of actions whatsoever, to my child or his/her property, arising out of or connected to participation in any CHEC programs. (Parent/Guardian Initials) *

Media Release: I do/ I do NOT give permission for my child to appear in media coverage approved by CHEC including newspaper articles, website, social media and on-site publications. *

I do give permission for my child to appear in media coverage approved by CHEC including newspaper articles, website, social media and on-site publications

I do NOT give permission for my child to appear in media coverage approved by CHEC including newspaper articles, website, social media and on-site publications

Day Camp Participation: CHEC reserves the right to terminate enrollment at any time if my child's behavior warrants dismissal. Any refund due for Day Camp fees will be prorated. (Parent/Guardian Initials) *

Pickup from Program: I understand the program ends every day at 3pm, unless pre/post care is approved. I will arrange to have my child picked at the specified time. If there are any changes in the persons authorized to pick up my child, I will notify the CHEC office at 941-475-0769 and the changes will be in writing. (Parent/Guardian Initials) *

I have carefully read and initialed each of the above parental/guardian consent sections. I fully understand that by signing this form I have given my parental/guardian consent for my child on all sections contained within. (Parent/Guardian Signature) *

Date *

YYYY

Parent/Guardian Printed Name *

A copy of your responses will be emailed to the address you provided.

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