FALL CAMP FORM

Would you like to add a membership?
yesno

Guardian Name *

Relation to Camper

Phone *

Email Address *

Would you like to list an additional guardian? *
YesNo

Guardian #2 Name

Guardian #2 Phone

Guardian #2 Email Address

Camper Information (Name, Age, Pronouns) *

Camper Information #2 (Name, Age, Pronouns)

Camper Information #3 (Name, Age, Pronouns)

Camper's address during camp week*

Physicians name and phone number *

Will your camper be taking medication during camp? *
YesNo

If so, list medications and times/regulations for administering child's medications

Please share any camper's conditions or health considerations that you feel are important for camp staff to know

Please list any learning or behavioral support your camper may need

Please list any allergies camp staff should be aware of

Does your child carry an inhaler?
YesNo

Will you be sending your child with an Epi-Pen that you would like to give camp staff permission to administer if necessary?
YesNo

Approved Pick up List for camper *

Is there anyone who DOES NOT have permission to pick up the camper? If so please list below

Additional Questions, Campers, or Comments

I have read and understand the COVID19 guidelines outlined and have answered the questions to the best of my knowledge.*
Yes

I ACKNOWLEDGE THAT DESPITE ALL OF THESE PRECAUTIONS, THE RISK OF CONTRACTING AND SPREADING COVID-19 CANNOT COMPLETELY BE ELIMINATED AND, ON BEHALF OF MY CHILD/CHILDREN, MY OTHER FAMILY MEMBERS AND MYSELF, I AGREE TO (A) ASSUME THAT RISK AND (B) HOLD HARMLESS THE HUNTER MUSEUM, INCLUDING ITS OFFICERS, DIRECTORS, EMPLOYEES AND REPRESENTATIVES, WITH RESPECT TO ANY ISSUES ARISING FROM OR RELATED TO COVID-19.
Yes

By clicking below, I agree to above waiver of liability for a minor.*
Yes

I consent to the above information and use of images of my camper(s) by the Hunter Museum of American Art.*
YesNo

Please indicate whether or not the name of the camper(s) can be used with aforementioned photos and/or recordings.*
YesNo

Please type your name below as signature. *

Please type todays date below to date your authorization. *