Camp Pride Korea Medical & Release Information Form
Parents and guardians only, please complete the following medical and release form for your camper and submit it by Friday, July 12, 2024.  This form should only take a few minutes to complete.
Email *
Child(ren)'s Name(s): *
Family Name *
Your Name *
Your phone number *
Your relationship to the camper(s). *
Is parent volunteering at camp? *
If Parent/ Guardian is not volunteering at camp please enter a contact name and phone number below: *
COVID SCREENING: Has your camper or campers experienced any cold or flu-like symptoms in the last 5 days (fever, cough, shortness of breath, muscle or body aches, headache, loss of smell, sore throat, congestion or runny nose, nausea/vomiting or diarrhea)? If so, please contact camppridekoreainfo@gmail.com. *
Please tell us any known allergies your camper/campers have (if none, enter N/A): *
Significant medical history that we should be aware of (if none, enter N/A): *
Daily Medications Required. (Parent must be available during camp to administer medication to their child). *
Date of last Tetanus immunization: *
In case of emergency and parent cannot be reached, please provide an alternative contact.                                        ** Include name, relationship and phone number. *
In the event of an emergency, I consent to my child receiving medical treatment as deemed necessary by the examining physician or medical professional. *
Physicians name and phone number. *
Insurance company and policy number: *
In the interest of offering your child the best possible camp experience, please feel free to share any additional needs or concerns below:
I GIVE MY FULL PERMISSION FOR MY SON/DAUGHTER TO PARTICIPATE IN THE CAMP PRIDE KOREA ACTIVITIES.  THE APPLICANT AND PARENT/GUARDIAN AGREE THAT CAFFA, HANMEE PRESBYTERIAN CHRUCH, ALL INSTRUCTORS, AND MEMBERS OF THESE ORGANIZATIONS WILL NOT BE HELD RESPONSIBLE FOR ANY ACCIDENTS OR LOSSES, HOWEVER CAUSED, AND AGREE TO RELEASE ALL PARTIES INVOLVED FROM CLAIM OR DAMAGE WHICH MAY ARISE AS A RESULT OF OR BY REASON OF SUCH LOSS OR ACCIDENT.   *
I ALSO GIVE PERMISSION FOR MY CHILD TO BE PHOTOGRAPHED FOR MARKETING USE BY CAMP PRIDE KOREA. *
Please provide your name, address, phone number to acknowledge the contents you completed within this form are correct. By submitting this form you agree to the previously stated releases as indicated. *
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