2017 Summer Field Camp

University of Idaho
875 Perimeter Drive MS 1142
Moscow, ID 83844-1142
Telephone: (208) 874-3946
Email: truj4218@vandals.uidaho.edu

Participant Information

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Medical Emergency Information

In Case of Emergency, Contact:
Relationship to Participant: *
 

MEDICAL RELEASE: My signature below indicates that I understand that my child is being enrolled in a summer camp program from 9:00 am to 3:00 pm July 26-28. As parent/ guardian, I understand that should my child need medical attention in an emergency, every effort will be made to contact me. However, in the event that I cannot be reached, I hereby grant permission for Justin Trujillio or another staff member designee to order emergency medical treatment, x-rays, routine tests, release of any personal contact information, and to provide/ arrange for transportation for my child to a medical care facility. In my absence, I hereby give permission for emergency personnel or a physician to provide medical treatment, hospitalization, injection, anesthesia, or surgery, should the situation call for any of these things. I understand that I will be financially responsible for all costs incurred by any medical situation. It is strongly recommended by us that you provide the medical insurance information above, prior to submitting this form.

GENERAL CONSENT: I understand that my child is being enrolled at my and his/ her own risk. In the event of an accident, I hereby consent to hold harmless all staff members.  I hereby waive my right to claims against any staff members. I understand that the summer camp times are 9:00 am to 3:00 pm, Mondays through Fridays. I will ensure that my child arrives on time and is picked up promptly at 3 pm. I will send a sack lunch with my child each day of camp. We ask that parents do not bring any food that contain nuts or peanut butter as children attending camp are allergic. I also understand that my child is expected to behave appropriately during all camp days, and may be asked to leave camp (without a refund). 

PHOTO RELEASE: My signature below also hereby grants permission for photos and/or videos of my child to be utilized by the University of Idaho in print, on television, and/or online.

Payment of $45 per child will be due on the first day of camp.
I have read, understand, and agree to all of the above information: *
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