RELEASE AND MEDICAL AUTHORIZATION
I authorize my child (listed below) to participate in AmpCamp at the University of Northern Iowa (“UNI”) from July 20 to July 24, 2025. I agree that Student will abide by all UNI policies at all times during AmpCamp. Should Student fail to abide by such policies or fail to behave appropriately during AmpCamp, Student may be prohibited from participating in AmpCamp.
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Student first name *
Student last name
Guardian first name *
Guardian last name *
Guardian mobile phone *
Guardian email *
Student Allergies
If none, enter "none"

Will the student require any accommodations to participate in AmpCamp? If so, describe the necessary accommodations below:

Authorization

I acknowledge and accept that by participating in AmpCamp, Student may be exposed to certain risks and I hereby assume all risks relating to Student’s participation in AmpCamp, including property loss or damage, personal injury and/or death resulting from any AmpCamp activity. In consideration of UNI providing the opportunity for Student to participate in AmpCamp, I agree to release, indemnify, defend, hold harmless, discharge, and covenant not to sue the University of Northern Iowa, Board of Regents-State of Iowa, State of Iowa, their officers, employees, and agents, and all participants in AmpCamp (collectively, the “Releasees”) from and against all liability, loss, damage, or cost, including claims and suits at law or in equity, for injury, fatal or otherwise, and property loss or damage arising out of or related to the student’s participation in AmpCamp and AmpCamp activities, whether caused by the negligence of the Releasees or otherwise. I further agree that this Release and Medical Authorization shall be construed in accordance with the laws of the State of Iowa.                 

In the event of any injury or illness, I give my consent for UNI to obtain medical treatment for the Student. I authorize and give consent for UNI personnel to administer general first aid for minor injuries of Student and to secure any necessary medical treatment (including injections, anesthesia, surgery, or other reasonable and necessary procedures) for Student by a licensed health care provider. I agree to assume all costs related to any such treatment.     
Agreement *
I have read the above statement authorizing my child to participate in Amp Camp 
Student name *
Parent name *
Date
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