Kindness Camp Registration 2023
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First and Last Name of Camper *
Street Address *
City *
State *
Zip Code *
Date of Birth of Camper *
Mother's First and Last Name *
Mother's Cell Phone Number *
Mother's Email Address *
Father's First and Last Name *
Father's Cell Phone Number *
Father's Email Address *
Emergency Contact Name (if parents cannot be reached) *
Emergency Contact Number *
Does the camper have any allergies/medical issues/or need to take any medications while at camp? Please be specific. If none, please type "none". *
Which camp(s) are you registering your child for?   *
Camper Shirt Size *
I give permission for my child to participate in Kindness Camp 2023. I understand that my child may be transported in the camp directors car or 15 passenger van to travel to locations to be determined. I am also aware that if the camp has more campers than what can fit in the directors’ car, another volunteer may be assigned to transport some campers. By typing my name below, I am stating that I am aware of all of the above. *
I agree to allow my child to participate in Kindness Camp 2023 and affirm that my child’s participation is completely voluntary. I understand that there can always be risks in the activities my child will engage in at the Camp.   My child and I are willing to assume all risks. To minimize the risk, I have instructed my child to obey all the rules, regulations and instructions of the camp.   In consideration for permitting my child to participate in the camp, I voluntarily agree, to assume full responsibility for any risks or loss, or personal injury that may be sustained while participating in Kindness Camp 2023.  By typing my name below, I am stating that I am aware of all of the above. *
I grant permission to Heather Stephenson and Sam's Wish volunteers,  the irrevocable and unrestricted right to produce photographs and video taken of my child while at Kindness Camp 2023 for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release Heather Stephenson & Sam's Wish and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child given during an interview during the camp.  By typing my name below, I am stating that I agree with the above.
Are you able to pay the $60 registration fee (made payable to Heather Stephenson) to hold your child's place at the camp or do you need a grant for this?  (no questions asked). The $60 will pay for everything needed for the camp, a camp t-shirt, and lunch. *
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