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Camper Information Sheet - Please print and snailmail!
Name____________________________________Date of birth____________________
Address________________________________________________________________
Telephone number(s): Home_____________________Work______________________
Mobile numbers (please indicate contact and number):
_______________________________________________________________________
_______________________________________________________________________
In case of an emergency, please give the name and phone numbers of the person you wish for us to contact if parents are not available:
1. Name_______________________________ Relationship to child________________
Address________________________________________________________________
Phone number(s):_________________________________________________________
2. Name_______________________________ Relationship to child________________
Address________________________________________________________________
Phone number(s):_________________________________________________________
Child’s pediatrician:_________________________Phone #________________________
Does your child take any prescription medicine? If so, please give the name of the medication and time taken: _______________________________________________________________________
Is your child allergic to the sun and/or sunscreen?_______________________________
Other conditions?_________________________________________________________
I hereby give Camp Seaview and/or Seaview Arts First Aid personnel permission to supervise the administration of this medication (additional forms will be required and sent upon receipt of this information).
Signature___________________________________Date________________________
I give permission for the properly certified staff to administer First Aid if necessary. In case of emergency, I understand every effort will be made to contact me or the person(s) above. In the event that no one can be reached, I give permission to the physician selected by the camp director to render proper treatment.
Signature___________________________________Date________________________
I give my child permission to participate in any of the supervised aquatic activities. Please describe your child’s swimming experience/ability:_________________________
Signature_______________________________________________________________
Parent/Guardian Agreement: I agree to have the medical form completed by a physician and returned to the camp director at least four weeks prior to the start of camp. Campers will not be allowed to attend camp if this form is incomplete. In addition, I allow my daughter to participate in camp activities and programs including field trips. I also authorize Camp Seaview/Seaview Arts to use photographs, video-clips of the camper as may be needed for camp records or promotional materials. Camp Seaview staff and programs emphasize mutual respect, cooperation and personal responsibility. The camp director reserves the right to dismiss a camper when his/her actions show disrespect for other people or property. I have read the above and understand the camp’s policies.
Signature____________________________________Date_______________________
I give permission for Camp Seaview/Seaview Arts staff to transport my son/daughter only when necessary and deemed appropriate by the camp director.
Signature____________________________________Date_______________________
Please print out and complete, then mail.
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Mail to Camp Seaview
PO Box 850
Marblehead, MA 01945
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