All starred (*) questions must be filled out in order to complete registration. All fields in the required sections must have a response. If there is no applicable response for that field, please put "N/A".

Please be sure to complete both pages of the survey.

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* 1. Camper Information

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* 2. Parent/Guardian Information 1

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* 3. Parent/Guardian Information 2

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* 4. Will the Parent/Guardian be joining us for the morning resource session? (Breakfast and Lunch included)

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* 5. Medical Information
Please ensure camper has all required medications for the day of camp.

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* 6. Will County-provided transportation be required for the camper to attend?
Pick-up/Drop-off location will be your local Police Department

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* 7. Primary Authorized Pick-Up (Must Be Over 18 Years Old)

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* 8. Authorized Pick-Up 2 (Must Be Over 18 Years Old)

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* 9. Authorized Pick-Up 3 (Must Be Over 18 Years Old)

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* 10. Are we permitted to use photos of your camper to help promote this event in the future?

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* 11. Release Information

By registering the above camper, I hereby state that the health history is complete and correct to the best of my knowledge. The Camper has permission to engage in all camp activities except as noted. It is my intention that the appropriate representative of the camp be treated as a “personal representative” for the purposes of disclosing protected health information, as necessary related to the person’s ability to perform camp related activities and to provide relevant information to the camp representatives to keep guardian/parents informed of my child’s health issues.

In the event I cannot be reached in an emergency, I hereby give permissions to the physicians selected by the camp to secure and administer treatment, including hospitalization for the camper named above. I understand that part of the Camp experience involves activities and group interactions which may be new to my child, and they come with certain risks and uncertainties beyond what my child may be used to dealing with at home. I am aware of these risks, and I am assuming them on behalf of my child, which I am legally authorized to do. I realize that no environment is risk-free and so I have instructed my child on the importance of abiding by the Camp’s rules and my child, and I both agree that he or she is familiar with these rules and will obey them.

Due to limited space, registration will be on a first come first served basis. I understand that completing this application does not guarantee my child a spot in Camp Cardinal.

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