Release of Liability & Media/Food Allergies

Are you a camp staff member or chaperone?

Yes

No

First Name

Middle Name

Last Name

Email Address

Birthdate

Address

Country

Street

City

Region

Postal Code

Dining & Allergies

Click here for the Allergen & Special Dietary Needs Guide

Do you have allergic reactions to any foods?

Yes

No

If other, please list allergy:

Are your allergens airborne?

Yes

No

Does cross-contamination trigger your allergen?

Yes

No

Do you carry an epi-pen?

Yes

No

Please tell us how you will transport this around campus should you require it:

Do you wear a medic alert bracelet?

Yes

No

If other, please explain:

Please add any information pertaining to your dietary and/or allergen concerns while on the Alma College campus that you feel is important we know about.

The signature of one parent or guardian serves as acknowledgment and consent from both parents or guardians. By typing your name below, you affirm that all medical and food allergy information provided is accurate, complete, and up to date.

Please have your student/child speak with a manager or chef during their meal time if they have any questions.

Parent/Guardian Information

Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Release of Liability, indemnification & Media Agreement

I, the undersigned parents/guardian, give permission for my child to attend and participate in the camp at Alma College. I understand this event will take place at Alma College and my child will be under the supervision of Alma College designated individual(s). I hold the college and all its staff and volunteers harmless for any injury or incident involving my child.

In the event of any emergency, I authorize Alma College to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for me or my minor child/ward's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I understand that this authorization includes transporting my child by ambulance if necessary to the nearest medical treatment facility if I am unable to be reached first.

PROMOTIONAL RIGHTS: As a condition of my participation, I hereby grant Alma College the right to use, for promotional purposes only, any photographs of me taken by Alma College, its employees or agents, during my participation in the Program. I further understand and agree that Alma College may use (for marketing purposes) any statements or quotes attributed to me in my evaluation of the Program.

It is understood that the signature on this consent form by one parent or guardian implies the consent of the other. By typing below I am stating the above information is complete and truthful.

Your Journey Starts Here

Release of Liability & Media/Food Allergies - UHS Band Camp