LYLP Camper Registration Form
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People that LYLP will contact and allow to pick-up campers.

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Please tell us about your child's medical or dietary status or issues.

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  1. Camper will attend all 4 weeks.
  2. Camper will bring LYLP shirt, sneakers, swim suit and towel daily.
  3. Camper will follow rules and instructions.
  4. Camper will be kind to counselors and other campers.
  5. Camper will bring a positive attitude and their best effort to all activities.
  6. Camper will not use cellphone during camp.

Camper understands that failure to follow these terms, may result in dismissal.

 

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  1. I give permission for my child to participate in all camp activities except those listed in the above medical restrictions.
  2. I give permission to LYLP to publish photos and videos of my child as part of LYLP activities.
  3. I understand LYLP is unable to provide camper specific 1:1 support or supervision.
  4. I understand that providing false or misleading information or failure to follow acceptance terms may result in camper dismissal.
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I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity.

It is understood that the Lowell Youth Leadership Program will provide no medical insurance for such treatment, and that the cost thereof will be at my expense.

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In consideration of the acceptance of my child's application for LYLP summer program, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child as a result of their participation in said summer program. This release is intended to discharge in advance the Lowell Youth Leadership Program, its officials, officers, employees, volunteers, and agents from liability. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees.

I give consent for my child to participate in the above summer program, and I execute the above liability release on my child’s behalf.

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Check 'Camper'
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Campers must be between 10 and 16 years old at the time of camp.
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School camper will attend in the fall.
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Parent or Legal Guardian Name
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Primary Care Physician's name or clinic name
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Physician's/Doctor's office phone number
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Insurance Company and Subscriber Number
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Please upload current health records 4M Size limit. At least 1 file is required
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Here you can upload another health record file. 4Mb max
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Here you can upload another health record file. 4MB Max
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