Camp Redwood 2019 Medical Information and Permission and Releases - Step 1 of 4Child's Name *Grades Anticipated Grade for the 2019-2020 School Year *Parent/Guardian 1 *Parent/Guardian 1 Email *Parent/Guardian 1 Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian 1 Phone Number *Parent/Guardian 2Parent/Guardian 2 EmailParent/Guardian 2 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian 2 Phone NumberWho will pick up your child from camp? Please fill out the names and relationship with your child for each authorized person for camp pickup.First and Last Name *Relationship to Child *First and Last NameRelationship to Child First and Last NameRelationship to ChildNextMedical InformationDoes your child have any allergies? *YesNoPlease Describe in DetailDoes your child take medication regularly? *YesNoPlease Describe in DetailNote: If your child needs to take medication during the camp day, you will need to come to the office to pick up and fill out a permission to administer form.Does your child have any medical condition or concern that the school needs to know about or that may impact their full participation in camp activities? *YesNoPlease Describe in DetailNote: If your child needs to take medication during the camp day, you will need to come to the office to pick up and fill out a permission to administer form.NextEmergency Contact InformationThree emergency contacts are required. One contact (minimum) must be different than the listed parents/guardians.Emergency Contact 1 Name *FirstLastEmergency Contact 1 Phone *Emergency Contact 2 Name *FirstLastEmergency Contact 2 Phone *Emergency Contact 3 Name *FirstLastEmergency Contact 3 Phone *Preferred Physician *Preferred Dentist *Preferred Hospital *Insurance Carrier *Policy Holder *Policy ID Number *NextPermission and Release FormI hereby grant permission for my child to use all of the play equipment and participate in all activities of the camp. *I AgreeI Do Not AgreeI hereby grant permission for my child to leave the school premises under the supervision of a Redwood faculty and/or staff member for neighborhood walks and walking field trips. *I AgreeI Do Not AgreeI hereby grant permission for the name and/or likeness of my child to be included in communication and marketing initiatives of the school. Internal and external marketing initiatives may include but are not limited to promotional literature published by Redwood Cooperative School, articles and/or photographs to be published in area newspapers and magazines, photographs and video featured on the Redwood Cooperative School website and on Redwood Cooperative School social media sites, and filmed segments to be aired on local television stations. *I AgreeI Do Not AgreeI hereby grant permission for the Director or authorized school personnel to take any steps necessary to obtain emergency medical care for my child, if warranted. These steps may include but are not limited to attempting to contact a parent, guardian, the child's physician or any of the persons listed on the emergency contact information provided to the school by the child's guardian. If the above mentioned cannot be contacted, school personnel may do any of all of the following: call another physician, call an ambulance, have the child taken to an emergency hospital in the company of a staff member. In the case of emergency, a physician and/or emergency and medical professionals may examine the child and administer such emergency medical treatment as deemed necessary. Without such permission, the school assumes no responsibility to medical attention. Any expense incurred while enlisting the help of a medical personnel as listed above will be borne by the child's family. *I AgreeI Do Not Agree In consideration of Redwood Cooperative School permitting my child to engage in extracurricular activities and/or athletic events, I hereby voluntarily assume the risk of accident, injury or damage to person or property. Furthermore, I voluntarily release and discharge Redwood Cooperative School, its employees, agents, representatives, coaches and volunteers from, without limitation, any and all actions, causes of action, claims, or suits relating to my participation in such activity. *I AgreeI Do Not AgreePhoneSubmit