Date of Birth
Parent/guardian email address
Address is the same as participant.
Wee FolksLittle FolksRanger CampExplorer CampVoyager CampOutdoor Adventure
Canyon Country ParkNewhall ParkNorth Oaks ParkSanta Clarita ParkThe CentreValencia Glen ParkValencia Meadows Park
Wee Folks, and Little Folks N/ARequires life vest (parents may need to provide)Not a strong swimmer but can touch in shallow water. No life vest requiredModerate swim ability/taken some swim lessonsFully able to swim and may take swim test with lifeguards in order to swim in deep water and jump off diving board
The information you provide here will be held in the strictest confidence. It will be kept on file in our binder or carried by the camp director on field trips.
Name of Physician
If yes, please list the allergies and describe the severity of the reaction (medication, seasonal, food, etc.)
Name of Insured
Relationship to Camper
PERMISSION TO PARTICIPATE/CAMP POLICIES AND PROCEDURES
I have the authority and voluntarily agree for my child to participate in City operated activities or programs, or any extension thereof.
I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims or property damage which may arise in connection with such activities or programs, against the Supervisors, City of Santa Clarita, and its elected and appointed officials, agents, and employees. As a parent/guardian, I hereby consent to treatment of my minor child for any and all medical procedures deemed necessary as a result of accident or injury. I further agree to pay any and all costs incurred as a result of said treatment. I hereby give permission to the City of Santa Clarita to use my child(ren)’s photographs as they see fit for promotional purposes. I understand the photographs belong to the City and I will not receive payment of any kind.
An original signature is also required, therefore, you will be asked to sign this form on your child's first day of camp.
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