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About FAC Pinewoods | Staff | Registration | Camper info | Kids at Pinewoods

Kids at Pinewoods

Parent and Guardian Responsibility Form and Medical Care Authorization Form

Please print out, complete, and sign this form, one for each camper under age 18. Submit all completed forms to the FAC office with final payment before arrival at camp.

Download a printable PDF version of this form.

I. For children attending camp with their parent or parents:

I/we, __________________________________________ , parent(s) of

______________________________ (child’s full name) accept full responsibility for my/our child named above while in attendance at Pinewoods Camp during

________________________________________ (name of session). I/we have read and agree to comply with the Pinewoods Camp, Inc. Rules for Campers under 18, and waive all claims, demands, causes of action, and suits for personal injury, property damage, and other liability that may occur to my/our child named above while in attendance at Pinewoods Camp.

signature of parent __________________________________ date _________

signature of other parent _____________________________ date _________

II. For children attending camp with a guardian (complete both sections):

I/we, __________________________________________, parent(s) of

_____________________________ (child’s full name) accept full responsibility for my/our child named above while in attendance at Pinewoods Camp during

______________________________________ (name of session). I/we have read and agree to comply with the Pinewoods Camp, Inc. Rules for Campers under 18, and waive all claims, demands, causes of action, and suits for personal injury, property damage, and other liability that may occur to my/our child named above while in attendance at Pinewoods Camp. In addition,

_____________________________________ (name of guardian over 18) has permission to authorize emergency medical treatment, as necessary, for the child named above.

signature of parent __________________________________ date _________

I, ______________________________________ (name of guardian over 18), accept full responsibility for

________________________________________ (child’s full name) while in attendance at Pinewoods Camp during

________________________________________ (name of session). I have read and agree to comply with the Pinewoods Camp, Inc. Rules for Campers under 18, and waive all claims, demands, causes of action, and suits for personal injury, property damage, and other liability that may occur to the child named above while in attendance at Pinewoods Camp.

signature of guardian ________________________________ date _________

This form must be provided by FAC to Pinewoods Camp, Inc., before arrival at camp in order for your child to attend.

Pinewoods Camp Inc. Parent resp. form.01 JS rev.04.30.04