Camp Forms to Fill Out

There are 2 forms below that need to be completed prior to your sailor’s arrival at camp. Please double check all information is correct before submitting.

Camper Pick Up Authorization Form
Youth Camper Health History

For Race Team sailors participating in Drop-In days, please fill out this GOOGLE FORM, prior to your arrival at camp.

Camper Pick-up Authorization Form

Camper's Name(s)

Class Name

Week/Session

Camps run Mon-Fri except 29er which runs Tues-Fri.

Full Name and Phone# of Authorized Individuals

The individuals you designate below shall be authorized to pick up your camper(s). Please include the names of any and all individuals you may arrange to have pick-up your camper(s). This extends to parents (yourself included), grandparents, house-keepers, nannies, any and all carpool drivers, and all emergency contacts.

PLEASE NOTE: All of the authorized individuals named above will be asked to sign your camper(s) in and out of Camp. Under no circumstances will SSA release your camper(s) to any individual who does not appear in the list above. You may amend this list as necessary by filing additional, supplementary Camper Pick-Up Authorization Forms. SSA will happily provide these upon request.

I understand all of the above and that this list will be adhered to and may be amended as necessary by emailing the office.

At the time of pick-up, the picking-up adult may be asked to produce government-issued photo identification. This is to ensure the safety of your camper(s). There will be no exceptions to this policy. Your full name will act as a signature below and acknowledges acceptance of this policy.

I understand all of the above and that government-issued photo identification is required.

Parent's Name as Signature

First Name

Last Name

Camper Health History

Child's Name

First Name

Last Name

Class Name

Week/Session

Current Residence

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (Parent or Legal Guardian)

First Name

Last Name

Emergency Contact (Parent or Legal Guardian) Phone

(###)

###

####

2nd Emergency Contact (other than Parent above)

First Name

Last Name

2nd Emergency Contact Phone

(###)

###

####

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?

If yes, please explain. If no, type N/A

Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive?

If yes, please explain. If no, type N/A

For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?

If yes, please list. If no, type N/A

For campers who reside outside the United States, a United States territory, or the District of Columbia: Attach record of vaccination or immunity on Department form MDH-896.

Full Parent or Legal Guardian's Name

I confirm that typing my name will act as my signature on this form.

First Name

Last Name

Camp Forms to Fill Out

Camper Pick-up Authorization Form

Camper Health History

Severn Sailing Association