Camper Registration eSig
Non-parent emergency contact
Date of last tetanus shot/booster:
ID number: Group number: Name of primary insured:
PhotographyI grant the right to photograph my child and use the photo reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the internet.
Non-prescription pain reliefI grant the right for Staff to give my child non-prescription pain reliever, if needed.
Release of liabilityI release Himmelbjgert Camp and Northwest Danish Association of any and all liability if my child is injured, falls ill or is disabled during the course of camp.
Medical/Surgical Release I understand that every effort will be made to contact me if my child needs emergency medical/surgical treatment, but if it is impractical to do so, I HEREBY GIVE MY PERMISSION to the physician selected by camp staff to secure proper treatment, to hospitalize, or order injection, anesthesia, X-rays, or surgery for my child as named above.
Leave this empty:
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Document Name: Camper Registration eSig
Agree & Sign