Everyone Belongs Camp: Camper Pre-Registration

ACKNOWLEDGMENT AND ASSUMPTION OF RISKS LIABILITY RELEASE AND INDEMNITY AGREEMENT The undersigned parent/person having legal custody/guardianship of the participant listed above, give permission for the participant to participate in all programs/activities. I acknowledge that there are certain risks associated with the activities, including, but not limited to, physical injury due to activity-related accidents, and physical injury due to transportation-related accidents, illness, or even death.

CONSENT TO TREAT I, the undersigned parent or guardian of the above camper understand and acknowledge that in the case an emergency or the illness of my child, the BCM/D will make every effort will be made to contact me before any emergency treatment is administered. If the leaders of BCM/D cannot reach me, I give them permission to admit my child into the care facility nearest that location if necessary. I release the agents of BCM/D from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the event activities.

PHOTO AND VIDEO CONSENT AND RELEASE I hereby give the BCM/D permission to take and use photographs and/or video of me and/or my child. I understand these photographs and/or video might be used for a variety of purposes, including print publications, online publications, presentations, websites, social media, television advertising, outreach activities, and news media. I understand that all photos and video footage are the property of the BCM/D and I will not be paid for these photographs and/or video footage and have not rights to them. I hereby waive any right to inspect or approve the finished product in which my or my child’s likeness appears.

Everyone Belongs Camp: Camper Pre-Registration

Campers Information

Parent/Care Giver Information

Emergency Contact

Camper Medical Information

Additional Family Members

Waiver and Liabilities