Swan White

Health Form and Photo Release

Must be completed by the parent/guardian prior to the start of camp. Fill out a separate form for each child.

2022 Summer Camp Health Form

"*" indicates required fields

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Hidden
Child's Full Name*
Child's Full Name*
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Home Address*
Emergency Contact (other than parent/guardian)*
If none, enter N/A.
If none, enter N/A.
If none, enter N/A.
I, the parent(s)/guardian(s), of _____________________________________ do hereby grant permission for my child to participate in Maymont’s summer camp program and activities. I understand that risk of physical injury is inherent in this program and activities. In consideration for participating in this program and activities, I agree to assume the full risk of any injuries, including damage, loss or death. I further understand and hereby waive and release Maymont Foundation, their officers, agents, and employees from any liability for any injuries that may result from this program and activities. The terms hereof shall serve as a release and assumption of risk for my heirs, executors, and administrators. I also authorize the Maymont Foundation staff and volunteers to act according to their best judgment in any emergency requiring medical attention. I further understand that my medical insurance carrier or I will be responsible for any expenses arising from said emergency or treatment. I have read this agreement and agree to the conditions stated above.
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