Group Camp – Minor Acceptance and Release Form

Please complete and submit this form no later than July 15.

Attending(Required)

Family Camp

Mother/Daughter Camp

Attending With(Required)

Participant Legal Name(Required)

First Middle Last

Sex Assigned At Birth(Required)

Female

Male

Birthdate(Required)

Age At Arrival At Camp(Required)

Participant Information

Participant Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone 1(Required)

Preferred Phone 2(Required)

Participant Parent Information

Parent Legal Name(Required)

First Middle Last

Participant Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone 1(Required)

Preferred Phone 2(Required)

E-mail Address(Required)

Parent / Guardian Acceptance & Release

Please initial each box acknowledging your informed release & provide supplemental information as requested.

Initials(Required)

I have read the WeHaKee Camp Guide and understand and agree to abide by all of the policies as they relate to my child’s participation at Camp WeHaKee and in all camp programs. In addition, I have discussed the contents of this guide with my child and understand that it is my responsibility to ensure their understanding and willingness to abide by these policies.

Initials(Required)

I have reviewed the camp program and activities. My child's participation status is as follows in Question 1.

Question 1: During my child’s attendance at Camp WeHaKee, I have reviewed the camp program and activities and I confirm that my child can participate in all camp activities:(Required)

Without restrictions

With the following restrictions

Please describe camp activity restrictions.(Required)

Initials(Required)

My child’s allergy status is as follows in question 2.

Question 2: What is your child's allergy status?(Required)

My child has no known allergies.

My child has a food allergy.

My child has a medicine allergy.

My child has an environmental allergy (Such as insect stings, hay fever, etc.)

Please describe your child's allergies.(Required)

Initials(Required)

My child’s dietary and nutritional status is as follows in question 3.

Question 3: What is your child's dietary and nutritional status?(Required)

My child consumes a regular diet.

My child consumes a regular vegetarian diet.

My child has the following special food needs.

Please describe.(Required)

Initials(Required)

My child’s medical insurance status is as follows in question 4.

Question 4: What is your child's medical insurance status?(Required)

YES, my child is covered by medical/hospital insurance.

NO, my child is NOT covered by medical/hospital insurance.

Insurance Company Name(Required)

Insurance Company Phone(Required)

Policy Number(Required)

Subscriber Name(Required)

First Last

Subscriber Number(Required)

Initials(Required)

I provide my consent for representatives of WeHaKee Camp for Girls to take and maintain images (photos, videos, etc.) of my child while a participant at Camp WeHaKee and Camp WeHaKee related events/activities, and that such images can be used for promotional purposes by Camp WeHaKee including but not limited to brochures, website, promotional videos, social media and other broadcast media as well as other Camp WeHaKee related media. I understand that images of my child used in Camp WeHaKee promotional materials will never be identified by full name. I also understand that Camp WeHaKee is not responsible for images of participants participating in WeHaKee activities, events, etc. that may be posted on social media or other broadcast means by others not related to or authorized by Camp WeHaKee.

Initials(Required)

I understand that the community of WeHaKee proudly embraces our well maintained cabins and other facilities. When a camper chooses to write on bunks, bathroom stalls or any other areas of camp it is deeply contrary to the culture of our camp. I acknowledge that if my child is found to engage in such activity, a minimum fee of $250 will be charged to the registration account.

Initials(Required)

I understand that WeHaKee Camp policy prohibits myself or my child from posting photos, video, logos or other images of WeHaKee or its participants on websites, social media sites, or other broadcast electronic means.

Initials(Required)

I confirm that I have legal custody of the participant listed above. As the parent/guardian of the child listed above, I release Camp WeHaKee from any form of liability as I have given my child permission to participate. I also understand that Camp WeHaKee, its staff and agents will not be held liable for any loss, including but not limited to injury or death.

Initials(Required)

As parent/guardian of the child listed above, I confirm that my child is currently vaccinated in accordance with the Centers for Disease Control and Prevention’s most recent Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger (including the following vaccinations for diphtheria, tetanus, pertussis, mumps, measles, rubella, COVID-19, PCV, Hepatitis B & A, Varicella/chicken pox, meningococcal meningitis).

Child's Vaccination Status(Required)

YES, my child DOES have all of these vaccinations.

NO, my child DOES NOT have all of these vaccinations.

*If NO to any of these vaccinations, please contact our Administrative Office as soon as possible.

Signature of Parent/Guardian(Required)

Date(Required)

I, agree to be a positive and respectful member of the WeHaKee community throughout my session at Camp WeHaKee. In addition, I have reviewed the WeHaKee Group Camp Guide and understand and accept what is expected of me as a member of the WeHaKee Camp community. I specifically understand what behaviors are acceptable and unacceptable at Camp WeHaKee as discussed in the Expectations at Camp section of the guide. Additionally, I agree not to post photos, video, logos, or other images of Camp WeHaKee or its participants on internet sites or other broadcast electronic means of any kind.

Signature of Participant(Required)

Date(Required)

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.