Camp Fire USA - Oneida Council & Camp Birchrock

Camp Birchrock Registration

Submitted by admin on Mon, 02/09/2009 - 15:51.

This registration form must be completed by the child's parent or legal guardian.
After submitting this form you should also complete the health forms and issue a deposit.

Personal Information

Name: *

Sex: *

Male

Female

Age: *

Birthdate:

Grade in fall: *

Address: *

City, state and zipcode: *

Family email: *

Parent/Legal guardian: *

Residential phone: *

Daytime phone (parent 1): *

Daytime phone (parent 2):

Other emergency contact:

Person other than parent or legal guardian for emergency only.

Other emergency phone:

Optional Additional Information

1. Are there any health problems or routine medications your child takes that the camp should be aware?:

Are there any unusual family situations that might affect your child while he/she is at camp (i.e. divorce, death, etc...):

Are there any other special comments or concerns that will help make your child's summer an outstanding one?:

Waiver of Liability

I give permission for my child's picture to be used by Camp Fire USA - Oneida Council & Camp Birchrock.
Use of such pictures may include, but is not limited to, brochures, videos and internet web sites promoting or reporting on the camp and/or the American Camp Association.
I waive any claims which may arise from my child's participation in Camp Fire USA & Camp Birchrock activities.
I understand that in case I cancel a camping program the deposit fee will not be refunded. (Parents are urged to contact the Camp Birchrock office for more information about their camping session in order to recognize the nature of the activity to which they are giving consent.)
I understand that in order to provide a safe and cooperative group experience, a child may be dismissed from the program for reasons including behavior, illness/injury or extreme cases of homesickness.
My child has permission to participate in all camping activities, including those off of campus, and be transported by camp for any camp activities away from camp property, or in cases that require medical attention."

Waiver Agreement: *

I Agree

Electonic signature: *

The waiver must be signed by the child's parent or legal guardian. Please sign the agreement by typing your name.

Days 'Til Camp

Camp has already started.

Testimonial:

I love sending my children to Camp Birchrock every summer. With just a week there, they come back with a month full of stories! I love the programs they have there too. I know while my children are there, they are safely having the time of their life!
Joan P. and children Alex, and Misty.
Read more testimonials

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