CampHCCForm

Camp HCC Registration
Week 1 June 19-23, 2023
Week 2 June 26-30, 2023
Youth entering kindergarten through 6th grade

* Indicates required field

Child 1 *

First

Last

Age *

Grade in Fall *

Sex *

T-Shirt Size *

School *

Child 2 *

First

Last

Age *

Grade in Fall *

Sex *

T-Shirt Size *

School *

Child 3 *

First

Last

Age *

Grade in Fall *

Sex *

T-Shirt Size *

School *

Child 4 *

First

Last

Age *

Grade in Fall *

Sex *

T-Shirt Size *

School *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please indicate Week 1, Week 2 or Both *

Special Requests/Other Information *

Primary Contact *

Relationship *

Phone Number *

Email *

Secondary Contact *

Relationship *

Phone Number *

Email *

Consent for Participation

I the parent/ guardian of the registrant, a minor, agree that the registrant and I will abide by the rules/ guidelines of the HCC it’s affiliated organizations and sponsors. Recognize the possibility of physical injury associated with the Camp HCC program and in consideration for the HCC, accepting the registrant for its programs and activities. I hereby release, discharge and or otherwise indemnify the HCC, its affiliated organizations and sponsors, there employees and associated personal, including the owners of facilities utilized for the program against any claims by or on behalf of the registrant as a result of the registrant’s participation in the program and or being transported to or from the same, which transportation I here-by authorize. Further permission must be granted by the HCC for the registrant without insurance coverage to participate.

Signature / Name *

Health of Participant/Agreement to Mandatory Guidelines

As a parent or legal guardian of the above participant, I hereby agree that I will not allow the participant to attend Camp if they are feeling unwell. Further, I will explain to the participant the need to follow the CDC guidelines for summer camps regarding use of a mask during designated activities. I understand that a temperature reading will be taken at registration and any participant with a temperature will not be permitted to stay for Camp.

Signature/Name *

Date *

Consent for Minor Medical Treatment

As a parent or legal guardian of the above participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry . This care may be given under whatever conditions are necessary to preserve the health and safety of the participant.

Signature / Name *

Date *

Medical Insurance *

Doctors Name *

Phone *

(Participation will not be denied based on whether or not participant is insured)

Photo/Video Consent

I/We grant permission for my child to have his/her photo/video taken and published on the HCC Programs public internet site or any other type of media.

Photo/Video Consent *

Please note our refund policy available on our website at https://www.huntcommunitycenter.org/programs.html

Submit

Camp HCC Registration​Week 1 June 19-23, 2023 ​Week 2 June 26-30, 2023Youth entering kindergarten through 6th grade

Consent for Participation

Consent for Minor Medical Treatment

Photo/Video Consent

Camp HCC Registration
Week 1 June 19-23, 2023
Week 2 June 26-30, 2023
Youth entering kindergarten through 6th grade