Parent/Guardian LIABILITY & CONSENT FORM Section 1 Name of the Camp: NESSP 2018 STEM Summer Camp on Environmental Science and Remote Sensing. Mission: Earth Organized by: Oregon State University Extension Service, Marion Count and funded by the Northwest Earth and Space Sciences Pipeline. Summer Camp Administrative Coordinator: Emily Parent Email: Camp Address: 1320 Capital St NE #110, Salem, OR 97301 Camp date(s): July 30- August 2, 2018 Equipment/supplies to be provided: All supplies provided. By participant: Sunscreen, water bottle, appropriate outdoor clothes and shoes. By summer day camp: All camp supplies, lunches, and snacks. Transportation for field trips. Physical activities to be undertaken include: General outdoor activities, hiking inherent in this summer day camp include bodily injury due to: accidental collisions with other camp participants, tripping/falling over uneven ground, unpredictable reactions to contact with plant materials, bee stings, insect bites, lightning strikes, falling into ponds or lake, falling tree material, injuries from working with craft tools, sunburn, and dehydration. Section 2 I acknowledge that there are certain risks inherent in summer day camps, including but not limited to those indicated in Section 1. I acknowledge that all risks cannot be prevented and I assume those risks beyond the control of the Camp staff. I represent that my minor child is able, with or without accommodation, to participate in this summer day camp, is able to use the equipment and/or supplies described above, and has obtained the required immunizations. Should my minor child require emergency medical treatment as a result of accident or illness arising during the field trip, I consent to such treatment. I acknowledge that Oregon State University Extension Services and Camp Leaders do not provide health and accident insurance for summer day camp participants and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify the trip leader in writing if my minor child has medical conditions about which emergency medical personnel should be informed. Section 3
Parent/Guardian LIABILITY & CONSENT FORM Section 1 Name of the Camp: NESSP 2018 STEM Summer Camp on Environmental Science and Remote Sensing. Mission: Earth Organized by: Oregon State University Extension Service, Marion Count and funded by the Northwest Earth and Space Sciences Pipeline. Summer Camp Administrative Coordinator: Emily Parent Email: Camp Address: 1320 Capital St NE #110, Salem, OR 97301 Camp date(s): July 30- August 2, 2018 Equipment/supplies to be provided: All supplies provided. By participant: Sunscreen, water bottle, appropriate outdoor clothes and shoes. By summer day camp: All camp supplies, lunches, and snacks. Transportation for field trips. Physical activities to be undertaken include: General outdoor activities, hiking inherent in this summer day camp include bodily injury due to: accidental collisions with other camp participants, tripping/falling over uneven ground, unpredictable reactions to contact with plant materials, bee stings, insect bites, lightning strikes, falling into ponds or lake, falling tree material, injuries from working with craft tools, sunburn, and dehydration. Section 2 I acknowledge that there are certain risks inherent in summer day camps, including but not limited to those indicated in Section 1. I acknowledge that all risks cannot be prevented and I assume those risks beyond the control of the Camp staff. I represent that my minor child is able, with or without accommodation, to participate in this summer day camp, is able to use the equipment and/or supplies described above, and has obtained the required immunizations. Should my minor child require emergency medical treatment as a result of accident or illness arising during the field trip, I consent to such treatment. I acknowledge that Oregon State University Extension Services and Camp Leaders do not provide health and accident insurance for summer day camp participants and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify the trip leader in writing if my minor child has medical conditions about which emergency medical personnel should be informed. Section 3
2018registration-form.docx