Check all that apply

Must be able to supply up to date medical records if neccessary.

I give permission for my child to participate in any of the following adventure/camp programs offered by Girl Scouts of Middle Tennessee: high ropes, team adventure, obstacle course, wagon ride (with or without cookout), rappelling, climbing, backpacking, canoeing, tree climbing, archery, kayaking, and sailing. I understand that if I have any questions or concerns about these programs (or risks involved in these programs), I can contact Girl Scouts of Middle Tennessee (615-383-0490 or 800-395-5318) for more information.

I give consent for my child to be videotaped, photographed or audio taped for use by Girl Scouts of Middle Tennessee. Furthermore, I consent that such photographs, films and recordings shall be their property, and they shall have the right to duplicate, reproduce, and make other uses of such photographs, films and recordings as they desire free and clear of any claim whatsoever on my part.

I hereby give permission to the medical personnel selected by Girl Scout staff to provide routine healthcare; to administer medications; to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child participant. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp staff to secure and administer treatment, including hospitalization, for the child participant named on this form. I also give permission for first aid certified program staff to administer first aid for minor medical needs (such as cuts and scrapes, sprains, stings and bites, etc.). Girl Scouts and/or hospital may photocopy this completed form.

Can be a parent

I hereby acknowledge that the Girl Scout Troops which meet at Holy Family parish is not affiliated with or supervised by the parish. I understand that this program is operated by the individual troop leader/service unit and acknowledge that the parish only provides meeting space for meetings by the Girl Scout Troops. I further understand and acknowledge that neither the parish nor the Diocese of Nashville conducts screening or background checks on the individual troop leaders. I also understand that neither the parish nor the Diocese of Nashville selects or supervises the troop leaders.

I hereby acknowledge that Camp Kaper Hollow reserves the right to implement COVID safety protocols for the 2024 session if public health conditions require. These protocols will follow published Girl Scout policy in that case. As always, if you feel sick, please stay home. Anyone who prefers to wear a mask is always welcome to do so.