FALL FEST 2022 PERMISSION FORM
Please complete the below permission form as it pertains to Fall Fest 2022 (October 22-23, 2022).

*Denotes a Required Field

*HAS THERE BEEN ANY CHANGES TO YOUR CHILDS MEDICATION LIST SINCE THEY ATTENDED SUMMER CAMP 2022?: IF NO, THE ABOVE LIST WILL BE COMPARED TO YOUR CHILDS SUMMER CAMP FORM AND FOLLOWED ACCORDINGLY. IF YES, WE WILL SEND YOU A MEDICATION CHANGE FORM THAT WILL NEED TO BE PRINTED AND SIGNED BY THEIR PHYSICIAN.

I hereby give permission for the above-named child to participate in the stated activity, and agree to the following:

CONSENT FOR MEDICAL TREATMENT:

*I HEREBY GRANT PERMISSION TO THE MEDICAL STAFF AT THE CAMP OR CONSULTING PHYSICIANS/NURSE PRACTITIONERS TO ADMINISTER ROUTINE AND ANY EMERGENCY CARE REQUIRED TO MYSELF IN THE EVENT OF AN EMERGENCY. I HEREBY GIVE PERMISSION TO THE MEDICAL PERSONNEL SELECTED BY THE CAMP DIRECTOR TO ORDER X-RAYS, ROUTINE TESTS, TREATMENT; TO RELEASE ANY RECORDS NECESSARY FOR INSURANCE PURPOSES; AND TO PROVIDE OR ARRANGE NECESSARY RELATED TRANSPORTATION FOR MYSELF IN THE EVENT OF AN EMERGENCY. IN THE EVENT OF AN EMERGENCY, I HEREBY GIVE PERMISSION TO THE PHYSICIAN SELECTED BY THE CAMP DIRECTOR TO SECURE AND ADMINISTER TREATMENT TO MYSELF, INCLUDING HOSPITALIZATION.

PERMISSION SLIP:

*I HEREBY GRANT PERMISSION TO PARTICIPATE IN THE FALL FEST EVENT ON OCTOBER 22-23, 2022, AT CAMP GOOD DAYS AND SPECIAL TIMES, INC.

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT:

*I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE CAMP GOOD DAYS AND SPECIAL TIMES AND ITS OFFICERS, DIRECTORS, SERVANTS, AGENTS AND EMPLOYEES FROM ALL LIABILITY, COSTS, EXPENSES, AND CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION WHATSOEVER ARISING, THAT MAY BE SUSTAINED BY ME, OR TO ANY PROPERTY BELONGING TO ME, WHETHER CAUSED BY NEGLIGENCE OF CAMP GOOD DAYS OR OTHERWISE. I AM FULLY AWARE OF THE RISKS AND HAZARDS, KNOWN AND POSSIBLY UNKNOWN TO ME, ASSOCIATED WITH BEING ON THE PREMISES AND PARTICIPATING IN THE CAMP. I HEREBY ELECT TO VOLUNTARILY ENTER UPON THE PREMISES AND PARTICIPATE IN THE CAMP AND ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, THAT MAY BE SUSTAINED BY ME, OR ANY LOSS OR DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF MY BEING A PARTICIPANT IN THE CAMP, WHETHER CAUSED BY NEGLIGENCE OF CAMP GOOD DAYS OR OTHERWISE.

PHOTO/ AUDIO-VISUAL/ MEDIA RELEASE:

*I HEREBY GRANT PERMISSION TO PARTICIPATE IN ANY AUDIO-VISUAL EVENT (INCLUDING PHOTOS AND VIDEOS FOR FUTURE CAMP USE) THAT MAY TAKE PLACE REGARDING THIS PROGRAM AND RELEASE CAMP GOOD DAYS AND SPECIAL TIMES, INC., AND EVERYONE INVOLVED OF ANY LIABILITY OR CLAIMS IN ASSOCIATION WITH THE MEDIA COVERAGE IF SUCH TAKES PLACE.