Name(s)

School

Grade in Fall

Parents

Phones

Address

City

Zip

E-mail Address

Emergency Contact

Check Week ($225 ea)

June 18 June 25 July 9

RELEASE OF LIABILITY
I authorize CAMP DRAW staff to seek medical attention for my child. If such attention is needed, I expect to cover my child’s health care costs and related expenses. I accept any and all risks and I release CAMP DRAW, its director, independent contractors and Glenwood School from any liability in connection with the activities of the camp. On behalf of myself and my children, I release those parties from all liability in connection therewith. I hereby waive my right and my child’s right to file a claim in court in the event of my child’s injury or death. I also understand the camp retains the right to use for publicity purposes, photos of the children or their artwork taken at camp. I have read this agreement carefully and fully understand its contents.

Name(s) of children

Parent or Guardian

Health Insurance

Doctor

Phone

Please inform us of any allergies or medical conditions
relating to your child.

Credit Card Information

Visa MC Discover

Account Number

Expiration Security CCV
(three-digit security code on back of card)

Name On Card

Billing Address

City

State Zip