Camp Kind Release Form

*ONE FORM REQUIRED PER CAMPER.

EMERGENCY CLAUSE*

I agree to the emergency clause.

In the event I cannot be reached in an emergency or if the situation does not permit contacting me, I give my permission to the employees of Ben’s Bells to secure proper medical attention for my child as deemed necessary.

PERMISSION TO WALK CLAUSE*

I agree to the permission to walk clause.

I authorize my child to participate in walking excursions during Ben’s Bells Camp Kind. Walking will be limited to the Downtown Area and campers will be accompanied at all times by Ben’s Bells Camp Staff and Volunteers.

MEDIA RELEASE*

I agree to the media release.

I authorize Ben’s Bells to photograph and/or videotape my child for publicity purposes (including visits from news media and photos on our website). Ben’s Bells will not release any personal information regarding my child other than his or her first name and age. I understand that these materials will be the property of Ben’s Bells, not to be sold or loaned, and will be used only to promote Ben’s Bells programs.

Name*

First Last

Camper Name*

First Last

Relationship to Camper*

Name

This field is for validation purposes and should be left unchanged.