top of page

EMERGENCY FORM 

I give my permission for my Child(ren) to participate in Camp Glow, an outreach of GLOW Mission co-op classes. Participation in any program which involves physical activity exposes a child to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect a child from all conceivable dangers. I affirm that my child(ren) has/have no conditions that would it unsafe for them to participate in the camp's classes. 

MEDICAL CONSENT

I understand the GLOW Mission staff will make every effort to contact me in the case of an emergency. I give my permission for the camp to administer medications needed in an emergency case and give my consent to any necessary medical treatment for my child(ren) while at camp including onsite and offsite emergency care. I accept responsibility for the costs of all such emergency medical treatment. 

By filling out and signing below this Waiver and Release of Liability with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren) attending classes at Camp Glow, the GLOW Mission, I hereby voluntarily release and discharge Camp Glow, The GLOW Mission, its trustees, officers, employees, agents, teachers, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising or related to my child(ren)'s participation in Camp Glow classes. 

please fill out information and sign below to agree to the above 

EMERGENCY INFO

Thanks for submitting!

bottom of page