Camper Registration Form
Eldritch Theatre's Sorcery and Sword Summer Camp
Camper Name *
Your answer
Camper Address *
Your answer
Camper Age *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Alternate Phone Number
Your answer
Names of trusted guardians for pick up/drop off other than that of above. *note if they are not on this list they will not be allowed to leave with this adult*
Your answer
Emergency Contact's Name + Relationship to Camper *
Your answer
Emergency Contact's Phone Number *
Your answer
Emergency Contact's Alternative Phone Number
Your answer
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe. Include any medications they may use during camp. *
Your answer
Camper bio, and things that would help them have a wondrous time with us had we only known this? *
Your answer
What level of gaming has this witch or warlock done in the past? *
Informed Consent and Acknowledgement: I hereby give my approval for my child’s participation in any and all activities prepared by Eldritch Theatre during the selected camp. In exchange for the acceptance of said child’s candidacy by Eldritch Theatre, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Eldritch Theatre and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.In case of injury to said child, I hereby waive all claims against Eldritch Theatre including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. *
Medical Release and Authorization: As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.Permission is also granted to Eldritch Theatre and its affiliates including directors, instructors, and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. *
Confirmation - BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. *
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