2014 Summer Camp Form

2014 Summer Camp Safety Form

At the Mizel Museum, your children's safety is our top priority. To ensure it, we need your help. Please fill out this form completely. You'll receive a confirmation email after you click on submit, indicating that we received your form. Campers can not attend camp unless we have your completed form on file. PLEASE COMPLETE A SEPARATE FORM FOR EACH CAMPER.
  • MM/DD/YYYY
  • Please list the name of the camp your child is registered for.
  • MM/DD/YYYY
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  • Please apply sunscreen before camp. If your child brings sunscreen, staff will reapply it if necessary if you initial above.
  • If your child does not have his/her own sunscreen and appears to need protection, staff has permission to apply the camp brand if you initial above.
  • Camp staff will administer prescription medication only with the consent of your child's doctor. YOUR PHYSICIAN MUST FILL OUT A MEDICATION ADMINISTRATION FORM. If your child uses an inhaler, camp staff must have parental notification. If this applies to your child, initial above, indicating that your child may utilize her/her own inhaler as needed.
    Will your child require camp staff to administer medication during camp? If you check Yes, you must print the Medication Authorization form, have it signed by your child's doctor and returned to the museum prior to the start of camp.
  • By initializing above, I hereby give my permission for the staff of Mizel Museum to call a doctor or the emergency medical service and for the doctor or emergency technicians to provide emergency or surgical care as needed for my child in the case of injury or illness. I will be responsible for all the expenses associated with medical care that my child may receive.
  • Before your child can attend camp, his/her immunization record must be on file at the museum. Please initial above indicating that you will provide a copy of your child's immunization record before the start of camp.
  • By initializing above, I understand that participation in a camp sponsored by Mizel Museum will involve outdoor and other activities that may present risks. I agree that: a) I accept the risks of having my child participate in the camp; b) I waive and release any claim I might otherwise have against Mizel Museum, or any other person or entity that owns any real or personal property used in the camp or any of their respective employees, volunteers, directors, sponsoring agencies or representatives, for any personal injury or property damage sustained in the course of or in connection with my child’s participation in the camp, whether or not resulting from the negligence of any person or facts or conditions that would give rise to premises liability. I agree not to bring suit on any claim covered by the waiver.
  • By initialing above, I understand that my child will be required to follow the instructions of the Mizel Museum camp staff. If my child does not follow instructions or if staff members determine, in their sole judgment, that my child’s behavior is disruptive or is endangering my child, other persons or property, camp staff will call you or another contact person designated above, and you will be responsible for picking up your child within one hour after the call. Depending on the severity of the problem, my child may not be allowed to return for the rest of the camp session, in which case I will not be entitled to a refund. I will be responsible for all expenses, damages or injuries caused by my child.
    I grant permission for the Mizel Museum, its agents, employees and personnel, the right to use photographs or video images taken during the 2013 Camp season, for the purpose of promoting the programs of the Mizel Museum, without compensation for its use. I understand and agree that photographs will become the property of the Mizel Museum. This includes use in publications such as advertising, direct mail, brochures, newsletters, magazines and in electronic media, including video and/or websites. I also grant permission to the Mizel Museum to offer said photography for use or distribution in other publications, electronic or otherwise, without notifying me. I release Mizel Museum from any and all liability related to the distribution of my child’s photo or likeness.
  • By including my name in the field above, you acknowledge you have read and understood the material herein and are authorized to sign this form as parent or legal guardian of the child named here.