Summer Camp Camper Information

Camper Information
*This form is to be completed after registering for camp and payment has been put through. Please submit only one form per camper.
Child's First Name*
Child's Last Name*
Child Birth Date*
MM slash DD slash YYYY
Grade Entering in Fall 2023*
T-Shirt Size*
Parent/Guardian #1 Name*
First Last
Parent/Guardian #1 Phone Number*
Parent/Guardian #1 Email*
Parent/Guardian #2 Name
First Last
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email
Other than Parent(s)/Guardian(s), please list who you are authorizing to pick up your child (Full Name, Relationship, Phone Number)
Emergency Contact Name*
First Last
*If neither parent, emergency contact, nor physician is available in case of emergency, Cheekwood will exercise judgement regarding medical treatment
Emergency Contact Phone Number*
Emergency Contact Email*
Physician Name*
First Last
Physician Phone Number*
Allergy or Medical Concerns?*
- Yes
- No
What is the Allergy or Medical Concern?*
Will you be leaving medication with your child?*
- Yes
- No
*Guardians leaving any medication with their child must complete a Medical Release Form.
Medical Release Form
Consent*
In the event of the medical emergency listed above, I hereby grant full permission for a Cheekwood employee to administer the treatment outlined below. I will hold harmless Cheekwood and its employees from legal responsibility for any outcome of the administration of medication.
Please list the medical emergency, the medication you are leaving with your camper & treatment plan*
If your camper needs any special attention or considerations, please briefly describe how we can best accommodate your camper. Please note that as we are not a special needs camp, there may be some needs that we are unable to meet.
Talent Release
By checking this box, I grant permission without restriction, to Cheekwood Botanical Garden & Museum of Art to record my child's voice, image, and likeness for use in Cheekwood Botanical Garden & Museum of Art's advertising, programming, promotional material, or for whatever purpose they may deem appropriate. I release Cheekwood Botanical Garden & Museum of Art from any liability for any such violation of any private personal or property rights which I might have in connection with such materials.
Do you grant permission?*
- Permission Granted
- Permission Not Granted

Summer Camp

Camper Information Form

Camper Information

Medical Release Form

Talent Release