Please list any medical conditions and/or allergies we should be aware of:
Please list any medications your child is currently taking:
Please list any medications that we will be giving your child during the camp day. List name of medication, proper dosage, how it is given (by mouth with water, with food, etc.), and the times the medication should be given. Oral medications ONLY (except emergency medications such as an EPI Pen).<.p>
If you have listed any medications that we will be giving your child (including over the counter medications), please sign below:
I give permission to SCHS staff to give the medication(s) listed above, according to the directions that I have listed above. I will provide proper containers with labeling to identify medication(s). Medication will not be stored overnight at SCHS and parent will only send “one day supply” of medication. Medication will be given directly to SCHS camp volunteer. If any medication information changes, I will inform camp staff of those changes.
Please use your mouse, touchpad, or finger to sign your name.
For cancellations made more than 4 weeks prior to the start of camp, you may transfer to any other week of camp that has an opening or elect to have your money refunded.
For cancellations made from 1 to 4 weeks before the start of your camp week, you may transfer to any other week that has an opening, or receive a voucher good for the amount paid. The voucher can be applied to Camp fees through the end of the following calendar year.
Cancellations made less than one week prior to the start of your week of camp, or individual missed days during camp, are non-refundable.
Safety is #1 for SCHS Campers! This is why only adults over the age of 18 who are listed below will be allowed to pick up your camper. Please list any adults who will be picking up your camper. If during the week you need to add someone to that list, you may do so. SCHS reserves the right to check ID of anyone picking up a camper.
In the event of an emergency, I give permission to Sheboygan County Humane Society permission to treat any injury my child suffers and approve any medical treatment by the physician selected by SCHS to hospitalize, secure proper treatment for, and to order injection and/ or anesthesia and/ or surgery for my child(ren) *
I consent to my child’s participation in all activities and trips, which are part of camp and under the direction of SCHS staff and volunteers.
I give permission to SCHS to use photographs, motion pictures, or videotapes of my child in publicizing and promoting SCHS’s work.
The undersigned parent or guardian of the minor listed on this form hereby consents to the minor participating in camp of the Sheboygan County Humane Society, “SCHS,” and all of its activities and programs. The undersigned, for herself or himself and on behalf of said Minor(s), does hereby absolutely and unconditionally release, indemnify, hold harmless and forever discharge SCHS, its employees, successors, assigns, and agents and each of them, from and against any and all claims, demands, obligations, and liabilities of every nature and kind whatsoever including, without limitation, negligence, occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such camp. As to matters covered hereby, the CONSENT AND RELEASE shall extinguish all claims, demands, and rights which the undersigned or the Minor (and/ or each of their heirs, successors, and assigns) has or may ever have against the parties released hereby, or any of them, for any injuries, costs or damages to the Minor occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such camp whether such injuries, costs or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable.
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