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Camper's Name
Parent or Guardian
Emergency Contact 1
Emergency Contact 1 Phone
Emergency Contact 2
Emergency Contact 2 Phone
Emergency Contact 3
Emergency Contact 3 Phone
Alternate Pickup/Release 1
Alternate Pickup/Release 2
Alternate Pickup/Release 3
Primary Care Provider
Primary Care Provider Phone
By checking the boxes below, I hereby give permission to give my child over the counter medications according to standard dose:
The majority of Theater in the Woods activities take place outside, with exposure to risks normal in outdoor activity. We will safeguard against normal foreseeable risks. At the same time, accidents can occur during the everyday course of events, and it is impossible for us to insure ourselves adequately against such occurrences. Therefore we ask you to take responsibility for providing adequate health insurance for your own child, and that you sign a waiver agreeing to indemnify us for any medical expenses. Your insurance information provided above enables reimbursement to be made for any medical care needed by your child in the duration of our day camp. In case of an emergency, and if a family physician cannot be reached, by checking the box below I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).
By checking the box below, I agree to hold Theater in the Woods Vermont blameless for any accident or injury which may occur to my child during the course of the camp, except in the case of gross or willful negligence, and I agree to indemnify Theater in the Woods Vermont against medical claims which may arise from my child’s illness, accident or injury.
Tuition for Bobcats or Wolves camp is $650. Tuition for one-week Bears camp is $325. I agree that I will use the payment button below to pay the full fee or a deposit of $200 upon submission of this form. I agree that I will pay the balance of $450 due by July 1, 2024 for Bobcats' camp or by July 22, 2024 for Wolves' camp, or the balance of $125 for Bears' camp by June 24, 2024. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. I agree to the tuition payment terms.
Electronic Signature
Check here if you will be mailing a check to accompany this form.