Date: {sign_date}
I hereby enroll: {name}
Address: {address}
Phone: {phone}
Child Date of Birth: {dob}
Parent or Legal Guardian:
Place of Employment:
Employer Phone Number:
I hereby give permission for photographs and videos to be taken of my child and The Floating Fox has the right to utilize these in camp brochures, electronic video, print display, social media, and other materials.
No, I do not want my child to be photographed
I hereby agree to comply with the rules and regulations of The Floating Fox regarding fees, attendance, health, parking, clothing, and other items specified in the policy statements issued by the camp.
MEDICAL INFORMATION
Child's Name: {name}
Any other information relating to the medical care of your child that our school/camp personnel need to know, such as daily medications, difficulty in swallowing pills, motion sickness, use of earplugs or glasses.
PICK UP AND EMERGENCY CONTACT LIST
Student Name: {name}
Emergency Contact Listed
Name: {contact_name}
Phone: {contact_phone}
Relation: {contact_relation}
Authorized Persons to Pick up Child and Other Emergency Contacts
Emergency Medical Care and Procedure I hereby grant permission for the director to take whatever steps may be necessary to obtain emergency medical care if warranted. The steps may include, but not limited to the following:
1. Attempt to contact a parent or guardian.
2. Attempt to contact the child’s physician (please include physician’s name & phone number.)
3. Attempt to contact you through any of the persons listed on the Emergency Contact List.
4. If we cannot contact your child’s physician, we will do any of the following:
a. Call another physician.
b. Call an ambulance.
c. Have the child taken to the emergency hospital in the company of a staff member.
5. Any expenses incurred under Item 4 (above) will be borne by the child’s family.
6. The camp/school will not be responsible for anything that may happen as a result of false information given at the time of enrollment.
7. The camp/school will not assume responsibility for a child who has not had all the necessary forms filed with the camp/school.
Physician Name:
Phone:
Emergency Hospital Preference:
Health Insurance:
I hereby authorize The Floating Fox to meet my child {name} at. School. My child's dismissal hour is His/her teacher's name is room number is .
I, we do hereby agree that in no way will we hold The Floating Fox. or any employee responsible if an unforeseen accident should occur while transporting my child(ren) to and from school.
What is your car number needed to pick up child in the school pickup line?
Parent or Guardian:
Date:{sign_date}