Parent/Guardian Name 1 *

First Name

Last Name

Parent/Guardian Name 2 *

First Name

Last Name

Child 1 date of birth *

MM

DD

YYYY

Are they a confident swimmer? *

YES

NO

Child 2 date of birth

MM

DD

YYYY

Are they a confident swimmer?

YES

NO

Child 3 date of birth

MM

DD

YYYY

Are they a confident swimmer?

YES

NO

Child 4 date of birth

MM

DD

YYYY

Are they a confident swimmer?

YES

NO

Consent to take part in activities *

Please check the box below to confirm you understand that the activities to be undertaken involve an element of risk (which is managed according to the risk assessment available on request) and you accept them as part of each activity's enjoyment.

yes

no

Consent to emergency medical treatment *

Camp Kernow will contact you before the commencement of any medical treatment, unless your child's condition is such that immediate treatment is required before contact with you can be made. Please check the box below to confirm you authorise Camp Kernow to consent to any X-ray, examination, anaesthetic, diagnosis, treatment, and/or hospital care that may be recommended for your child/ren by a licensed physician or dentist.

yes

no

Consent to administer medication *

Please check the box below to confirm your authorisation of Camp Kernow staff to administer first aid and (where applicable) your child/ren's prescription medication as prescribed by a physician.

yes

no

*