Full name: _____________________________________
Address:______________________________________
_____________________________________________
School:_________________ Date of Birth:__________
Father's Name:_________________________________
   Daytime telephone:__________________________
Mother's Name:________________________________
   Daytime telephone:__________________________
Parents' Email:_________________________________
My daughter knows how to swim:_____Y    ____N

Participation Agreement:
To preserve PNWL's standards, the number of campers is limited. The directors reserve the right to refuse admission or request withdrawal of any camper if it is deemed necessary to protect the program's welfare.
The camp is not responsible for lost and/or damaged personal property.
Parents agree to abide by camp rules regarding phone calls, visitors, etc.
Parents understand that any photographs or videos taken of their daughter during the camp activities may be used in future camp promotional materials.
Parents also agree to hold the organization harmless from liability on account of injuries suffered by their child. Any claims for injuries shall be limited to the insurance coverage available for camp purposes.

Medical Release Form:
Check one:
____My daughter(s) has no serious medical problem and may participate in any of the activities of the PNWL camp.
____My daughter has a medical condition that requires the following restrictions:
______________________________________________

Insurance Company and Coverage:
I hereby give permission for my daughter(s) to receive emergency medical care should it be necessary during her stay at the PNWL Camp.
I also certify that I have read the Participation Agreement and agree to its terms.
 

______________________________________________ Parent/Guardian                                                 Date