Day Camp and Adventure Camp Registration 2023
Branch Adventures @ Camp Victory - 8513 Centerline Rd., Saranac, MI 48881
4 Days - Monday, June 26- Thursday, June 29
cost: $95.00
Please fill out a registration for each camper

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Email *
Which Camp is this registration for? *
Camper's Last Name *
Camper's First Name *
Camper's Gender *
Camper's Birthday *
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Grade Camper Will Be Going Into Fall 2022 *
Camper's Shirt Size *
Name of the Responsible Adult (parent or legal guardian) Filling Out this Registration:
E-Mail Address *
Mailing Address *
Phone Number *
1st Emergency Contact Information (Name and Phone Number) - if information is the same as Name and Contact Information from above, simply state "Same as Above" *
2nd Emergency Contact Information (Name and Phone Number)
Names of Adults Authorized to Sign Camper Out at the End of the Day *
List any Allergies - food, medications, bees or other
List any special needs, limitations, or adaptations your child has, either physical, behavioral, or dietary that we should be aware of in order for your child to participate in all aspects of camp life.                         You may also use this space to tell us anything about your camper that was not otherwise asked or addressed on this form.
Medical History
Medication to be given during Camp Hours: MEDICATION, DOSAGE, and TIME of Administration  (medication must be in original container and will be given to the Medical Officer)
Insurance Carrier, Policy Holder Name, Policy Number *
Branch Adventures’ Medical Officer has permission to administer, as needed, over the counter pain reliever, antacid and antihistamine, as well as, bug spray and sun screen, unless otherwise noted.   *
Required
I state that my child is in good health and that all the information on this form is true to the best of my knowledge.  I take all responsibility for the health of my child.  I authorize the Branch Adventures staff to consent medical or dental care or both for my child if emergency contacts cannot be reached.  I grant their authority to include administering and authorizing routine medical care, any x-rays, anesthetic, medical or surgical diagnosis or treatment and hospital care under the supervision and upon the advice of a physician and surgeon licensed for medical practice for my child.  I further authorize the Branch Adventures staff to receive physical custody of my child upon completion of any treatment.  I will not hold Branch Adventures responsible for any injury to my child and I will take care of all medical costs. *
Required
I acknowledge that participation in camp activities incurs a certain amount of risk.  My child has permission to voluntarily participate in the daily youth camp activities that may include but are not limited to: hiking, games/sports, wagon rides, low rock wall, initiatives course, swamp run and swimming. *
Required
I give Branch Adventures permission to use photos/likeness of my child for promotional use. *
Required
I certify, by the electronic signature of my name typed below, that I am the Parent or Legal Guardian of the above named camper and that the information submitted through this form is true. *
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