Camp Con Brio 2021 Online Registration
PARENTS AND GUARDIANS must complete all of the information requested to register your child for camp. None of this information will be shared with outside parties. The only adults who will have access to this information are the Camp Con Brio Camp Director and Camp Nurse.
Camper's First Name *
Camper's Last Name *
Grade of Camper in Fall 2021 *
Age of Camper (while at camp) *
Instrument *
Camper's Gender (for rooming assignments) *
Camp you would like your child to attend *
Middle School (entering grades 6-8) or High School (entering grades 9-12). If there are questions, please email and ask. CampConBrio@gmail.com
Camper's Adult T-Shirt Size *
Roommate Request(s)
*We will try to honor all roommate requests. Rooms may have as many as 8 people per room. Requests can only be honored if campers request each other.
Parent/Guardian First Name *
Parent/Guardian Last Name *
Address (Number and Street) *
Number, Street, Apartment or Unit Number (if applicable), City, State, Zip
Address (City, State, and Zip) *
Number, Street, Apartment or Unit Number (if applicable), City, State, Zip
Home Phone Number *
example: 555-555-5555
Parent/Guardian's Cell Phone and/or Emergency Contact Number *
example: 555-555-5555
Parent/Guardian's Email Address *
Camper's Health Insurance Provider and Policy Number *
example: Kaiser Permanente, Policy number 134567890
Camper's Known Allergies and Sensitivities, Including Food *
Please include ANY AND ALL allergies or sensitivities. Example(s): peanuts, gluten, dogs, honey, rag weed, chlorine, etc.
Severity of any Food Allergies listed above *
Required
Camper's Known Ongoing Medical Conditions *
Please include ANY AND ALL conditions. Examples(s): frequent headaches, asthma, anxiety, celiac, etc.
Camper's Required Medications and Doses (INCLUDING over-the-counter medications) *
These must be provided to the camp in a current pharmacy or company labeled container, and should be medications the camper takes regularly or as needed. Example(s): Lactaid, 1 in the morning at breakfast and 1 in the evening at dinner
The above named camper is in good health and is able to participate fully in all String Camp activities, WITH THESE EXCEPTIONS: *
By typing my full name, my initials, and the date below, I give the Camp Con Brio Nurse, Director, and Administrator permission to administer Acetaminophen, Ibuprofen, Decongestants, Diphenhydramine (Benadryl), Antacids, or other over-the-counter medications to my child as deemed necessary. *
example: Edith E. McStrings EEM 1/10/2021
By typing my full name, my initials, and the date below, I hereby authorize Camp Con Brio staff to act for me and my child in the event of a medical emergency if the parent/guardian cannot be contacted. I understand that Camp Con Brio is not liable for any medical costs incurred, and that parent/guardian will assume all financial responsibility. I hereby release the camp and staff from any and all liability for injuries or illnesses incurred at camp, or while traveling to or from camp. *
example: Edith E. McStrings EEM 1/10/2021
By typing my full name, my initials, and the date below, I hereby grant permission to Camp Con Brio the right to capture, use, reproduce, and/or distribute photographs, films, videotapes, and sound recordings of my child, without compensation or approval rights, for use in materials created for purposes of promoting the activities of Camp Con Brio. *
example: Edith E. McStrings EEM 1/10/2021
By typing my full name, my initials, and the date below, I hereby acknowledge that cell phones and other electronic devices are prohibited at Camp. I understand this policy is put in place due to a lack of service or wifi, along with the camp's mission to provide the best musical and outdoor experience possible for my child. I will not send any electronics to camp with my child and understand that Camp Con Brio is not responsible for any lost, stolen or broken devices. If my child is seen with and electronic device, I understand that it will be confiscated until the conclusion of the final concert. *
example: Edith E. McStrings EEM 1/10/2021
My child wishes to participate in recreational activities to be made available to participants at Golden Bell Camp including activities that may be hazardous or otherwise involve a risk of physical injury or death to the participants (the “Activities”). I expressly assume any and all risks of injury or death arising from or relating to the Activities including agricultural recreation and waive and release any and all actions, claims, suits or demands of any kind or nature whatsoever against Golden Bell Camp, its corporate affiliates, contractors, vendors, officer, agents, sponsors, volunteers or representatives of any kind (collectively “Releases”) arising from or relating in any way to my child's voluntary participation in these activities. I understand that this Waiver, Release and Indemnification agreement means, among other things, that if I am or if my child is injured or die as a result of participation in these activities, I, and/or my family or heirs cannot under any circumstances sue. Releases or any of them for damages relating to or caused by my injuries or death. I agree to indemnify Releases or any of them, and their subrogees, if any, in the event of any loss, damage or claim arising from or relating in any way to my participation in any of the Activities. I also hereby grant permission to Golden Bell Camp the right to capture, use, reproduce, and/or distribute photographs, films, videotapes, and sound recordings of my child, without compensation or approval rights, for use in materials created for purposes of promoting the activities of Golden Bell Camp. I have read this Waiver, Release and Indemnification Agreement, have asked and received answers to any questions I had concerning its meaning and execute it freely, without duress, and in full complete understanding of its legal effect, and of the fact that it may affect my legal rights. *
Type your full name, my initials, and the date below. Example: Edith E. McStrings EEM 1/10/2021
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy