Camper Registration

Parent/Guardian #1 Contact Information

Full Name

First Last

Prefix

Mr.

Ms.

Mrs.

Other

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Work Phone

Occupation

Employer

Parent/Guardian #2 Contact Information

Full Name

First Last

Prefix

Mr.

Ms.

Mrs.

Other

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Work Phone

Occupation

Employer

Child lives with

Consent

The purpose of the above listed information is to ensure that medical personnel have details of any medical problems which might interfere with or alter treatment.
I understand that I will be notified in the case of a medical emergency involving my child. If I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services if my child is injured or becomes ill.
In case of an emergency, and if a family physician or parent/guardian cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (EMT/First Responder/Physician).

Parent / Guardian Initials(Required)

I understand that Wholly Informed Sex Ed/Camp WISE/The First Unitarian Church of Dallas will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Parent / Guardian Initials(Required)

Photo/Publicity Release

I have full power and authority to grant the rights stated in this document. I hereby give permission for my child to be photographed and/or recorded on video during Wholly Informed Sex Ed activities. I understand the photos/videos may be used to keep a journal of activities and/or testimonials to share during presentations and/or reports to our donors and for promotional purposes including flyers, electronic and digital media, online or mobile advertising, social media and print. I understand that my child’s likeness may be used for promotional purposes. I do not expect compensation and all photos/videos are the property of Wholly Informed Sex Ed and its affiliates.

Parent / Guardian Signature(Required)

Transportation Release

I hereby give permission for the transportation of my child for official Wholly Informed Sex Ed/Camp WISE activities by modes of transportation agreed to by the camp organizers.

Parent / Guardian Initials(Required)

Wholly Informed Sex Ed/Camp WISE is not responsible for lost or damaged personal property. Daily camp schedules are subject to change.

I have read this entire document and understand/agree to its contents.

Parent / Guardian Signature(Required)

Date

Printed Name of Parent/Guardian(Required)