I understand that participation in The Naming Project and Bay Lake Retreat Center activities involves certain degrees of risk. I have carefully considered the risk involved and have given consent for myself and/or my child to participate in these activities. I understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release, hold harmless and agree to indemnify The Naming Project and Bay Lake Retreat Center, employees and related parties or other organizations associated with the activity from any and all claims or liability arising out of this participation.

I approve the sharing of information on this form with The Naming Project and Bay Lake Retreat Center staff who need to know medical situations that might require special consideration for the safe conducting of The Naming Project and Bay Lake Retreat Center activities.

In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual(s) listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the staff in charge to secure proper treatment, including hospitalization, anesthesia, surgery or injections of medication for me or my child.

Medical providers are authorized to disclose to the staff in charge examination findings, test results and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. I understand and agree that medical decisions related to care and treatment may be based upon information supplied in the appropriate health form submitted.

During the week of The Naming Project camp, my child will be supervised by The Naming Project and Bay Lake Retreat Center staff, and that my child will abide by the rules set forth by both organizations. I understand that my child can be dismissed from camp for reasons including, but not limited to: chronically disruptive behaviors, illegal activity, breaking of camp rules, contagious illness, self-harm, or destruction of property. If my child is dismissed from camp, I understand that it is my responsibility to arrange and pay for transportation for my child to return home.

I have read and understand all the information shared in this form. If any information I/we have
provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in an event or activity.