Registration Form
Content
Sylvania Wilderness
Mini-High Adventure Camp July 28-August 1, 2010 Registration Form Sign-up Ends July 12th - $25 Deposit Due July 12th Name of Participant: ___________________________________________ Emergency Contact Information:
Name: _______________________________ Name: ________________________________ Relationship: _________________________ Relationship: __________________________ Contact #(s): __________________________ Contact #(s): ___________________________
Parental Informed Consent and Hold Harmless/Release Agreement
I understand that participation in Scouting Activities involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in these activities. I understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for puposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
Participant’s Name ________________________________________________________ Participant’s Signature _____________________________________________________
(if participant is over the age of 18)
Parent/guardian’s signature _________________________________________________
(if participant is under the age of 18)
Date:
_______________, 2010
Mini-High Adventure Camp July 28-August 1, 2010 Registration Form Sign-up Ends July 12th - $25 Deposit Due July 12th Name of Participant: ___________________________________________ Emergency Contact Information:
Name: _______________________________ Name: ________________________________ Relationship: _________________________ Relationship: __________________________ Contact #(s): __________________________ Contact #(s): ___________________________
Parental Informed Consent and Hold Harmless/Release Agreement
I understand that participation in Scouting Activities involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in these activities. I understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for puposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
Participant’s Name ________________________________________________________ Participant’s Signature _____________________________________________________
(if participant is over the age of 18)
Parent/guardian’s signature _________________________________________________
(if participant is under the age of 18)
Date:
_______________, 2010
