Camper Information
Camper Name
Gender
Grade
Allergies
Medicine
Camper Name
Gender
Grade
Allergies
Medicine
Camper Name
Gender
Grade
Allergies
Medicine
Parents Information
Parent/Guardian Name
Phone Number
Mailing Address
Parent/Guardian Name
Phone Number
Mailing Address
Emergency Contact
Name
Relationship
Phone Number
-
Area Code
Phone Number
Name
Relationship
Phone Number
-
Area Code
Phone Number
I/We hereby give consent for the above child(ren) to participation in all activities and experiments prepared by Gordon’s Laboratory. I/We agree not to hold Gordon’s Laboratory and all its respective staff, volunteers, and representatives liable for any loss or injuries sustained by my child(ren). There is a risk of being injured that is inherent working with laboratory equipment and chemicals.
Yes
No
I/We hereby delegate Gordon’s Laboratory and its respective staff, volunteers, and representatives to seek, obtain, and approve any medical care and treatment needed and rendered under the general supervision of any physician or surgeon which, in their judgement, is necessary for the health and well-being of said child(ren) during his/her participation in Gordon’s Laboratory Science Camp.
Yes
No
I/We understand any medical charges will be billed to me personally or directly to my insurance company.
Yes
No
I/we consent to allow all pictures taken of above child(ren) to be used for publicity and/or advertising materials for Gordon’s Laboratory to include video, website, print, and social media. They will not be reproduced for sale in any form.
Yes
No
I/We understand that if my child(ren) exhibit behavior that may cause harm to themselves, other campers, or staff they will be asked to leave the program. These behaviors include, but are not limited to hitting, kicking, biting, sexual harassment, and/or possessing weapons or illegal substances.
Yes
No
Submit
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