2009 Summer Registration (via Email)

Date of Birth

(one person who must also request this camper)

Cost Calculator

*Camp Cost:

Minus Registration Fee:

Mail your $25 registration fee. The balance will be due the day camp begins.

Family Discount:

First registration, full price; each additional child - $25.00 off

Approved Campership Amount:

Camperships are designed to cover the difference between what a family can pay and the actual fee. No camper will be turned away for financial reasons. Contact the Registrar to request a campership

Church Voucher:

Required only if church is paying part or all of camper’s fee.

Balance Due Upon Arrival:

 Medical Information

Physician’s Name:

Physician’s Phone Number:

Allergies:

 Nuts  Dairy Products   Bee Sting   Hay/straw   

Penicillin Other   

Does your child have any life-threatening allergies:

Does your child use an inhaler?

Medical Condition:

Has your child ever had:

Seizures   Heart Disease    Homesickness   Diabetes   

Asthma   Other   

Does your child have any medical problems?

Specify any medication your child is bringing:

Date of last tetanus shot:

Activity restrictions:

Can your child take Tylenol?

Name of Father or Legal Guardian:

Name of Mother or Legal Guardian:

Medical Release:

In case of an emergency, I authorize Camp Presmont to call a doctor or practitioner to administer medical aid treatment for my child at any time when they believe an emergency exists. In addition, I give parental permission for treatment and/or admission to a medical facility. Release & Indemnity Agreement: In signing this document, I hereby certify that I give permission for my son or daughter to participate in the camping program at Camp Presmont. I also give permission for my son or daughter to be transported in vehicles for camp approved activities. I also authorize Camp Presmont to use photographs, video and audio clips, including those of my son or daughter in camp publicity. In consideration of permission granted the herein named individuals to participate in camping activities, we hereby release and covenant with Camp Presmont that we will never, individually or as legal guardians of said individuals, institute any action at law or in equity for any personal injuries, or injuries to property, real or personal, accused by, or arising out of camping and other related activities sponsored by Camp Presmont, its successors and legal representatives; we further agree to indemnify and hold Camp Presmont harmless against any and all cost, damages and expenses which may be incurred by them as a result of any law suit we might file against them. We understand and acknowledge that camp activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and we and the participant expressly and voluntarily assume all risk of personal injury sustained while participating in aforementioned activities whether or not caused by the negligence of the released parties. Signature of Parent or Guardian: Note: If this form is being signed for a minor at the camp, it must be signed by both parents unless one is deceased or mentally incompetent. If there has been a divorce, the party having custody of the child should sign. If the child has no parents, this form must be signed by the legal guardian of the child.