Happy Girls Are Prettier

Dream Kamp

PARTICIPANT INFORMATION

Parent/ Guardian Information


Health Information
The information you provide will be in the strictest confidence. It will be kept on file in our health binder or carried by the camp director when your child travels on the campus with one of our camp groups.
Does your child have any allergic reactions to sunscreen?
May we serve your child good and non alcoholic beverages?
If your child must take medication while at camp, please note here. All medications must be in their origincal containers and be appropriately labeled. Please do not give your child's medication to them to bring to camp; medications must be received and held by the camp office or with the camp director.

Is your child up to date on all state required immunizations

Insurance information

Is the participant covered by family medical/hospital insurance?

Authorization of Consent

(I)(We), the undersigned parent(s) of my child, a minor, do hereby authorize any hospital for the undersigned to consent to any X-Ray examinations, anesthetic, medical or surgical diagnosis or treatment, or hospital care which is deemed advisable by, and is to be rendered under the genereal or special supervision of, any physician and/ or surgeon licensed under the provisions of the Medical Practices Act. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which aforementioned physician, dentist and/or surgeon in the excercise of his/her best judgement, may deem advisable. These authorizations shall remain effective until Date here, unless sooner revoked in writing delivered to said agent(s).

Individual Contract

To the extent allowed by law, I, the undersigned am the parent/guardian of the individual(s) named below and shall hold harmless, indemnify, and defend Dream Keepers, Inc the trustees of Dream Keepers, IC and the officers, employess, volunteers, agents and actors of each of them from and against any and all liability, loss, damage, expense, cost of every nature, and causes of actions arising out of or in connection with any negligence in the performance if this agreement. It is further understood and agreed that this waiver, release and assumption of risk to be binding on my heirs and assigns. I also release Dream Keeper, Inc. of liability for any claims that may arise out of acitivity. Dream Keepers, Inc. also reserves the right to remove participants from the program if they present a threat to the children or if they abuse the privilege of the mission statement of Dream Keepers, Inc, I also understand that participation in the program can cause servere injury or death and I have taken care to enroll at the level of his/her/my/our physical abilities and/or medical conditions. I hereby grant permission to Dream Keepers, Inc. to take my photo while participating in the activities to use for publicity. One parent/guardian must sign for all minors.

I have read this entire Informed consent Agreement. I fully understand it and I agree to be legally bound by it.
ENROLL
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