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WinterBlast- Friday-Sunday on Friday, January 4, 2019 @ 1:00 PM

Above please enter camper's name as attendee. 



Questions? Email Anna Roberts


Camper Info
*Camper's Age
*Camper's Grade
*Camper's Gender
List all allergies, health issues, and surgeries.
List all medications needed, including dosage and times.
You may list one camper who you would like to room with. While there is no guarantee that you will bunk with this person, we will do our best to honor your request.
Parent/Guardian Info
*Parent/Guardian Name
*Parent/Guardian Home Phone Number
*Parent/Guardian Cell Phone Number
*Parent/Guardian Email Address
Emergency Contact (other than parent/guardian)
*Name(s)
*Phone Number(s)
Camper's Medical Insurance Information
*Policy Holder
*Provider
*Policy Number
Should emergency medical care be needed for your child(ren), WSEFC personnel are required to have authorization to act on your behalf to accept their "Authorization of Emergency Treatment" form. By signing below I hereby give consent and permission for WSEFC personnel to authorize emergency treatment for my child(ren). I accept responsibility for possible injury or illness encountered while involved in WSEFC related activities. I release WSEFC and their employees and volunteers from all claims and liability arising from participation in Awesome Adventure. I authorize the reproduction, sale, copyright, internet web posting, exhibit, broadcast, and/or distribution of Awesome Adventure photographs, sound recordings, and/or videos that include my child(ren), and I waive any right to compensation for any of the foregoing (with the understanding that my child's personal information such as name will not be included in any such materials.)
*Electronic Signature of Parent/Guardian
*Date