90th Registration Form | Fleur de Lis Camp

90th Registration Form
POSTED 3.12.19 Blog

Name *

First

Last

Reunion Stay Length *

All tickets should have been purchased on square prior to filling out this form.

Phone Number

Email *

Mailing Address

Street City, State Zip

Emergency Contact Information *

Name - Number - Relationship

Years Attended Camp and Positions Held

Example: 2000-2007 Camper 2007 Queen 2008-2009 CT 2010-2014 Field Staff 2015 Mid Unit Head

Tent or Cabin Preference

90th Committee will do it's very best to get you back in a tent or cabin. Please know that we can not guarantee where or who you will be with for the overnight stay.

Tent/ Cabin Mate Request

The 90th committee will be working hard to make cabin/ tent lists for all in attendance. If there is someone that you would like to share a tent or cabin with for the 90th please leave their full name below and we will do our best to keep you together.

Other Information

Is there any other information regarding dietary restrictions, allergies, sleeping habits, etc. that you would like the committee to know prior to your arrival at camp?

Volunteer - during the reunion

If availability is limited (I.e needing to arrive late, leave early, etc.) please let us know.

Treatment Release: I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. I understand that part of the Camp experience involves activities and group living arrangements and interactions that may be new to me, and that they come with certain risks and uncertainties beyond what I may be used to dealing with at home. I am aware of these risks, and I am assuming them for myself. I realize that no environment is risk-free, and so I know the importance of abiding by the Camp’s rules, I agree that I am familiar with these rules and will obey them. I hereby give permission to the camp to provide, seek, and consent to routine health care, administration of prescribed medications, and emergency treatment for me, as may be necessary, including, but not limited to x-rays, routine tests and treatment, and/or hospitalization. I also give permission for the camp to arrange related transportation. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. *

Photo & Video Release: I acknowledge that Fleur de Lis Camp may take photographs and videos of me engaged in various aspects of the camp program, both on and off Fleur de Lis property, for both the benefit of promoting Fleur de Lis Camp and to preserve the summer's memories for campers and their families. I understand that Fleur de Lis would like to post these pictures and videos to its website, www.fleurdeliscamp.org, and on Fleur de Lis' social media sites, to share these memories with the parents, guardians, and families of the campers. Fleur de Lis Camp may also use photographs and/or videos of campers in camp publications such as the camp website, camp Facebook page, camp brochure, camp clothing catalog, camp newsletters (either in print or electronic), in the camp calendar, commemorative/recruitment DVDs, YouTube clips, and other print or electronic materials used to promote Fleur de Lis Camp. All pictures and videos taken are taken and used for Fleur de Lis Camp purposes only. I understand that these photographs and/or videos will not be sold or distributed to third parties or third party companies, or placed on any other internet web sites without my written permission, except as described in this release. Photos and DVDs may be purchased, but exclusively by campers and their families (NOT the general public). *

Full Name *

By typing your name here you agree that the information you entered above is accurate.

Birthdate *

month/date/year

Comment

90th Registration Form POSTED 3.12.19 Blog

SHARE:

90th Registration Form
POSTED 3.12.19 Blog