“Can’t
wait for next year’s
outdoor ed!” .
Tara, student, Forest Park
Adventist School
Please Print and Mail Form
- call to reserve space!
-360-708-3286
What to Bring!
Academic Adventures P.O. Box 1504, LaConner, WA 98257 360-708-3286
Day Camp Application: Pre-registration required! Call 360-708-3286
Camp Name:_________________________ Camp Dates:______________
Fees: ________ (see listing for fees)
Camper Name (please print)__________________________________
(Send check to: Academic Adventures P.O. Box 1504,Laconner, WA 98257)
Or Credit Card: _______________________________ exp date:_________
Name as appears on Card______________________________________
Billing Address for Card_____________________City__________St___Zip_____
Home Phone_________________ Parents Cell __Mom __ Dad________________ Work_______________ Email Address*:_________________________________
Home Address:____________________City______________St____Zip_______
*email used to communicate meeting location and class information/updates - please verify.
Academic Adventure Camp Guidelines: Parents, please review rules with your camper and sign.
1. I will be respectful of camp instructors and fellow campers
2. I will be a careful listener and follow directions
3. I will stay with my assigned group
4. I will have fun!
I have read the Academic Adventures camp rules and I will obey these rules. I understand that if I do not follow these rules, my parent(s)/guardian(s) may be called to come and pick me up at any time and without refund.
Camper Signature:_________________________ Parent/Guardian Signature________________________
Authorization for alternate parent/guardian Pick-Up
The persons listed below are authorized to pick my child up from camp.
Name:__________________ Relationship:_____________ Phone# Cell__________________
Other______________
Name:__________________ Relationship:_____________ Phone# Cell__________________
Other______________
I understand camp ends at 3:00 PM and will pick up my camper at this time.
Parent/Guardian Signature________________________ Date _____________________
Note: Please Advise Staff of any daily medications that are physician prescribed.
__________________________________________________________________
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Authorization of Consent to Treatment of a Minor
In the event of a medical emergency this allows medical treatment for your camper.
Camper Name:_________________ Parents Phone #’s - Home__________________
- Work___________________
- Cell____________________
- Other___________________
I/We, the undersigned, parent/guardian of _____________________, a minor, do hereby authorize Academic Adventures LLC staff, as agent(s) for the undersigned to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or specific supervision of any physician and surgeon licensed under the provisions of the Medical Practices Act on the medical staff of a licensed hospital, whether or not such diagnosis or treatment is rendered at the office of said physician or hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician, in the exercise of his/her best judgement, may deem advisable.
This authorization shall remain in effect for one year from this date ____/___/___
Unless sooner revoked in writing and delivered to said agent(s).
We hereby give permission for my/our child to attend the Academic Adventures programs and field trips. I give the group leaders permission to take any necessary action in the event of an emergency.
Parent Guardian Signature____________________________ Date_________________
Allergies______________________________________________________________________
Precautions or Activity Restrictions:________________________________________________
Please list any important medical or behavioral history__________________________________ ______________________________________________________________________________
Release of Liability – Accidental Injury
I, _____________________ the parent/guardian of _______________________ hereby acknowledge that my child I freely and voluntarily have chosen to participate in an Academic Adventures program. I hereby agree to save and hold harmless Academic Adventures LLC, participating private entities, and/or any cooperating or sponsoring public entities and their respective agents from any liability for accidental personal injury or property damage which I or my child may suffer while participating in an Academic Adventures program. I realize that pictures may be taken at camp by Academic Adventures for memories and/or marketing purposes and hereby give my permission for my child to be photographed.
______________________ _________________ ________________
Parent/Guardian (print) Signature Date
Cancellation Policy - Academic Adventures
Canceling 60 Days or more before camp - Full Refund
Canceling 30 - 59 Days before camp - 50% Refund
Canceling less than 30 days before camp - No Refund
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