Youth/Child Registration Form
This form will take you about 10-15 minutes. The information you share will help us provide the best expereince for your child at Camp HOPE. If you have any questions or concerns, please email or call our Executive Director, Maria Loy, at email@example.com or (608)-621-0633.
Please note, the medical history portion asks for your physician's name and phone number, the date of your child's last Tetanus vaccination, insurance information (if applicable), and any medication (with dosage) your child will need to take at Camp HOPE. You may want to have that information readily available before starting this form.
Are they shy, outgoing, loving, caring, kind, love to be around people, overwhelmed by loud noises, etc? What do you love about your child? What do they excel at? What do they struggle with?
behaviors, remarriage, aggression, anxiety, sleep issues, mental health concerns, suicidal thoughts, hospitalizations, etc.
I have read, understand, and agree to abide by the operating policy of Camp HOPE
The primary emphasis of Camp HOPE is to provide an opportunity to share experiences, make connections with others who have experienced similar losses, learn coping strategies and above all relax and enjoy nature. Camp HOPE and the programs presented are not intended to be used as a substitute for physician or psychiatric care. Participants understand that by enrolling they are agreeing to take part in the retreat voluntarily and remain responsible for their own physical and emotional choices. By signing this registration you are agreeing to release and hold harmless Camp HOPE and its representatives from any and all liability.
All information is confidential.
Authorization to Disclose Camper Photos and Videos
I authorize Camp HOPE to release my camper’s image and likeness taken during the Camp HOPE program. The purpose of this disclosure is to promote the program, and/or fundraise for Camp HOPE. The image and/or likeness can also be used for Camp HOPE’s marketing efforts, including, but not limited to, a brochure or video promoting Camp HOPE, or other educational programs or fundraising events for Camp HOPE.
Right to Revoke: I understand that I have the right to revoke this Authorization at any time by giving Camp HOPE written notice of the revocation. I understand that any revocation will not apply to any disclosure that has already been made in reliance upon this Authorization. I understand that I have the right to refuse the use of my camper’s image and likeness below and that my refusal will not affect my child’s experience. I understand that I may request a copy of this signed Authorization. A copy of this document is valid as an original. The original is not required to be shown. The Authorization will expire on December 31, 2033.