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Zip / Post Code
Additional emergency contact
Child's Primary Physician and Phone number
Are there any medications or medical conditions that we should be aware of or that a medical personnel should need to know about if an emergency occurred and you could not be reached?
Does your child have any allergies?
Does your child require a special diet?
How did you hear about the Day Camp?
While the Swedish American Museum will take all reasonable steps to provide individual safety for your child, the Museum will not assume responsibility for any injury, damage, or harm that might result during the course of any activity during the program. In permitting your child to participate, you expressly agree that all such responsibility will remain with and is assumed by you, as the parent or guardian of the child, and release the Swedish American Museum , its trustees, officers, employees and agents from any and all liability. If a medical emergency arises, every effort will be made to contact you or the person designated on your registration form. However, if you cannot be contacted immediately, you agree to authorize the Swedish American Museum or its employees or agents to request and authorize, at your expense, emergency medical treatment. By submitting this form, you agree that you have read this liability waiver and grant permission for your child to participate fully in this program.
By checking this box, you agree that you have read this photo release and that you hereby grant the Swedish American Museum, and their legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of the minor listed on this form, or in which that minor might be included, for editorial, trade, advertising and any other purpose and in any manner and medium including electronic usage (websites, photo disks, email, online stock, etc); to alter the same without restriction; and to copyright the same. You hereby release the Swedish American Museum and its legal representatives and assigns from all claims and liability relating to said photographs.