Archbishop Ryan High School

Camper Information

Camper #1

First Name: *

Last Name: *

Middle Initial:

Birth Date: *

(MM/DD/YYYY)

Grade entering in September: *

Current School: *

T-Shirt Size: *

Medical Waiver: *

I/We the parents/guardians of above student, state that he/she is in good health and has my permission to participate in the Archbishop Ryan Summer Camps. I authorize the staff at the camp to provide emergency first aid in the event of sickness or injury. I also give my permission for the teacher/coach/staff member to sign for me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand I am financially responsible for any medical bills incurred by my child while at the Archbishop Ryan Summer Camps.

Liability Release: *

I/We hereby release camp directors, organizers, teachers, staff members, coaches, workers, Archbishop Ryan High School, and any agents, volunteers, or employees of the above from any and all liability and any manner of actions, suits, damages, claims, and demands arising from participation in the camp.

Medical Conditions:

Please list any medical conditions the camp workers/volunteers should be aware of.

Medical Insurance Company: *

Policy Number: *

Camper #2

First Name: *

Last Name: *

Middle Initial:

Birth Date: *

(MM/DD/YYYY)

Grade entering in September: *

Current School: *

T-Shirt Size: *

Medical Waiver: *

I/We the parents/guardians of above student, state that he/she is in good health and has my permission to participate in the Archbishop Ryan Summer Camps. I authorize the staff at the camp to provide emergency first aid in the event of sickness or injury. I also give my permission for the teacher/coach/staff member to sign for me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand I am financially responsible for any medical bills incurred by my child while at the Archbishop Ryan Summer Camps.

Liability Release: *

I/We hereby release camp directors, organizers, teachers, staff members, coaches, workers, Archbishop Ryan High School, and any agents, volunteers, or employees of the above from any and all liability and any manner of actions, suits, damages, claims, and demands arising from participation in the camp.

Medical Conditions:

Please list any medical conditions the camp workers/volunteers should be aware of.

Medical Insurance Company: *

Policy Number: *

Camper #3

First Name: *

Last Name: *

Middle Initial:

Birth Date: *

(MM/DD/YYYY)

Grade entering in September: *

Current School: *

T-Shirt Size: *

Medical Waiver: *

I/We the parents/guardians of above student, state that he/she is in good health and has my permission to participate in the Archbishop Ryan Summer Camps. I authorize the staff at the camp to provide emergency first aid in the event of sickness or injury. I also give my permission for the teacher/coach/staff member to sign for me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand I am financially responsible for any medical bills incurred by my child while at the Archbishop Ryan Summer Camps.

Liability Release: *

I/We hereby release camp directors, organizers, teachers, staff members, coaches, workers, Archbishop Ryan High School, and any agents, volunteers, or employees of the above from any and all liability and any manner of actions, suits, damages, claims, and demands arising from participation in the camp.

Medical Conditions:

Please list any medical conditions the camp workers/volunteers should be aware of.

Medical Insurance Company: *

Policy Number: *