Camper Release Form - 2019 Highlander District Day Camp
This is the Camp Release Form for participants at Highlander District Day Camp June 17 - 21, 2019 at St Elizabeth Ann Seton Catholic Church, 1000 Andrews Rd, Fayetteville, NC 28311.
Email address *
Pack Your Bags for a Passport to Adventure!!
Scout's First and Last Name (will be used on name tag) *
Your answer
Gender *
Age *
Your answer
Unit *
Your answer
Determining Rank
Use the chart above to determine what rank your child will be at day camp. Use the grade level they will be in for the Fall of 2019.
Scouting Rank *
Mailing Address *
Your answer
Emergency Contacts Parent name and phone number *
Your answer
Emergency Contacts name and phone number other than parent *
Your answer
Person(s) authorized to pick up scout
Your answer
Person(s) NOT authorized to pick up scout
Your answer
Please list any medical conditions or physical characteristics camp staff must be aware of: *
Your answer
BSA Annual Health and Medical Record (AHMR) part A & B is required for scouting events 72 hours or less. This form is good for one year. List the date of your child's current BSA AHMR part A & B and please submit a copy of this form to camp with a copy of your child's insurance card attached before June 6, 2019. *
Your answer
BSA Annual Health and Medical Record (AHMR) part A & B
$10 late fee if required forms are not submitted by June 6, 2019.

Camp staff needs time to prepare for your child’s needs and organize participants into dens.
If your child requires medication while at camp, YOU (parent/guardian) MUST notify the child’s camp den walker and indicate medications on the BSA Annual Health and Medical Record (AHMR).

YOU (parent/guardian) MUST turn in all medications to the camp nurse/medic for accountability, per BSA policy. Medications that must be carried by a youth need a Physician's note. Instructions for giving medicine should be on the medicine bottle and AHMR. The camp nurse/medic is the only person authorized to give medications to scouts.
Sunscreen Statement
The staff of Highlander District Camp may apply sunscreen to exposed skin surfaces, prior to sun exposure, to my child. Sunscreen will not be applied to any broken skin or if a reaction has been observed. Any reaction observed by staff will be reported to the parent/guardian. No spray on sunscreen allowed.

Only sunscreen lotions or creams are permitted.
Sunscreen Permission
Uniform Requirements
Camp t-shirt, pants or shorts and closed toed shoes.
Media Release
I hereby assign and grant to Highlander Day Camp, Occoneechee Council, and the Boy Scouts of America the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the Boy Scouts of America, and I specifically waive any right to any compensation I may have for any of the foregoing.
Media Release Agreement *
Behavior and Code of Conduct Contract
While we recognize that children need discipline at some point and time, a Scout who consistently requires disciplinary action creates an environment that is not enjoyable and potentially unsafe for him and others. All Scouts attending Cub Scout Day Camp will follow camp rules and standards of behavior. Carefully read the contract below with your child, and sign it. By signing the contract, both you and your child agree to camp expectations and fully understand the consequences of inappropriate behavior. All Campers as well as staff are expected to be respectful and kind to others.
As a Scout, I understand that a camp that is safe and fun for everyone must be maintained. I understand that un-scout like behavior will result in disciplinary action in accordance with the Camp Discipline policy. Certain behavior, including but not limited to hitting, biting, and inappropriate language, bullying or creating an unsafe environment will result in a call to my parents for immediate dismissal from camp.
As a parent/guardian, I understand and have discussed the camp expectations with my child. I agree that if my child is dismissed from camp for disciplinary reasons, I am required to pick them up immediately and without reimbursement of fees.
Parent/Guardian Signature ________________________________ Date: ________
Scout Signature __________________________________________ Date __________
** This contract is required to be signed by Cubs and parents/guardians prior to boy being allowed to attend day camp.**
If you have any questions, please contact the camp director at or 910-213-6726.
Your answer
Thank you for registering your child for 2019 Day Camp.
If you have any questions, please contact the camp director at or 910-213-6726.
To finalize your registration process, fill out the forms below:
The information from this form will be used to create a release form for you to sign.
parent's Youth Protection Training certificate (online course -
Please bring a copy of your child's BSA Health and Medical form part A & B to camp (no doctor visit needed).
If you need this form go to
Please mail BSA Health and Medical Form Part A & B, youth protection certificate, and First Aid/CPR/AED training certificate (if certified) to Michelle Sweeney 6116 Garden Court, Fayetteville, NC 28311.
or turn in at Round Table OR Parent Orientation Meeting
(dates listed at
A copy of your responses will be emailed to the address you provided.
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