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Teen Camp Emergency Form

Steps

  1. 1. Step One
  2. 2. Step Two
  • Step One

    1. Session Registered for

    2. There Will Be a Late Fee of $15 for Payment After This Date

    3. Gender

    4. Please use Format (111)123-1234

    5. Please use Format (111)123-1234

    6. Please use Format (111)123-1234

    7. My child may watch movies that are rated

      Check All That Apply

    8. My child has permission to sign themselves out of camp to walk or ride a bike when weather permits and understand all waiver conditions apply.

    9. Does the hospital have permission to administer emergency treatment which may be necessary at the time for your child’s well being?

    10. If you check “NO” give specific instructions on this page for the camp to follow if you or the person designated cannot be located. In case of serious accident or illness, we attempt to contact you in order to explain the situation and let you decide what is to be done. Occasionally we cannot locate the individuals listed on the form. This is the reason we ask for your permission to take your child to the hospital when it seems necessary. Children are transported to the hospital Paramedics. The Paramedics cannot remain at the hospital nor bring the child back. This is your responsibility. If we cannot locate you to accompany your child, a counselor will accompany your child and the Paramedics to the hospital. Mayfield Heights Recreation does not provide insurance for campers. Each participant must provide his/her own insurance.

      No refunds after May 26, 2017. If a child is withdrawn from camp before camp begins, $15 will be retained by the City of Mayfield Heights to cover administrative costs.

      Note: Permission is granted for my child to take scheduled Field Trips with the camp under the supervision of the Teen Adventure Camp.