Camp Consent Form

Requested by Birchwood Early Learning
Monday, July 1, 2024

06202024_021004








Address

Primary Parent / Guardian

Alternate Parent / Guardian

Informed Consent: I authorize my child to participate in the Birchwood Summer Camp, which I understand may involve, but is not limited to the following activities: walking to and from local areas, indoor/outdoor games and activities and playing on playground equipment. I am aware and acknowledge that certain risks of injury are inherent to participation in sports and recreational activities.

These types of injuries may be minor or serious and may result from one's actions, or the actions or inactions of others, or a combination of both. Birchwood staff may secure such medical advice and services as it, in its sole discretion, may deem necessary for the participant's health and safety and I shall be financially responsible for such advice and services. I declare that I have read, understood, and agree to the contents of the Informed Consent Form in its entirety.

I agree that Birchwood or its employees, servants or agents shall not be liable for any injury to the participant or loss or damage to the participant's personal property arising from or in any way resulting from the participation in these activities

Sign Out Consent: At the end of each day children must be signed out before being permitted to leave the day camp. A child will only be released to a parent/guardian or emergency contact as listed. ID may be required before releasing a child.

Program Fees: There are no full or partial refunds of camp fees unless the camp is cancelled by Birchwood. Camps need 10 children registered to run. Fees will be refunded in full if camps are cancelled.

If you have any questions regarding the collection of this information, please contact: Sandra Wain, Program Director via email at swain@birchwoodearlylearning.com

Payment

Once you have submitted this form, your information will be reviewed and an invoice with the total amount for the Camp(s) you have selected will be sent to the Primary Parent / Guardian Email specified above.

Please note that your spot is not guaranteed until final payment has been processed.

Signature

Please use your finger, mouse or stylus to sign in the box below.