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Emergency Info &
Terms of Agreement

Medical Information

Please list any health or/and medical conditions for your camper(s). Allergies, medical devices, medical conditions, etc. Any information you want us to know about your camper.

If medication at summer camp is necessary, a written statement from a physician and parent authorization (signature) is required stating the method dose, and time schedule by which such medication is to be given. This pertains to prescription & over the counter medication.

Emergency Contacts

If an emergency should arise which requires immediate medical attention and we, as parent(s)/guardian(s) cannot be contacted, you are authorized to take whatever steps are needed to protect the health of my camper(s).

I authorize you to protect the health of my camper(s)
Read and check each statement below. These are required to register for camp.

Admittance to Camp – A child shall not be admitted to camp until all of the Camp Registration requirements have been received. I understand that Mr. Von Hoyningen Huene’s (Mr V's) Summer Camp is not a special needs camp and therefore cannot provide services to accommodate a special needs camper. My child is physically, emotionally, socially, and cognitively able to participate in the activities scheduled for camp, and will participate in all camp activities without infringing upon the rights of others (This includes but is not limited to – fighting, stealing, abusive language, or other negative behavior) Camp Activities offered at this camp include games, crafts, water play or sports that involve running, kicking, throwing, jumping, etc.. which may add increased risk, and I understand that injuries may occur and permit my child to participate in such activities.

Camp to Home Communication – All communication between Admin and the families of this camp, is done via email, phone, or flyers sent home with student. It is imperative that you submit your cell phone and email address during the enrollment process. It is your responsibility to read all correspondence sent home by the camp to make sure you are aware of all camp happenings, announcements, reminders, news, etc. All emergency-related messages will be relayed through text, phone call, or email.

Childs's Image – I give permission for photographs and videos of my child(ren) to be used for publicity purposes of Mr. Von Hoyningen Huene’s (Mr V's) Summer Camp and Ellovate, Inc.

Consent for Medical Treatment – In case of an emergency, permission is hereby granted to Mr. Von Hoyningen Huene and consultant physicians to treat my child, to carry out essential diagnostic procedures, and to make necessary referrals to private physicians or other community facilities.

Medical Emergency – I understand that if emergency medical or dental treatment is needed and the listed emergency contacts cannot be reached, 911 will be called. I realize Mr. Von Hoyningen Huene’s summer camp and Ellovate, Inc. cannot assume responsibility for the payment of medical fees for expenses incurred. I also agree that the emergency contact may transport my child between summer camp and home when, in his discretion, it is deemed necessary. I understand that it is my responsibility to inform Mr. Von Hoyningen Huene’s summer camp of any changes regarding the information on this form.

Student Allergies/Asthma/Other – If a child requires an inhaler, EpiPen, or other medication to control an allergy or other medical condition, the family must provide a written plan from the child’s physician to include the following information: Name of student, name of the medication, dosage, and instruction on how to administer the medication correctly. The family must provide 2 duplicates of the medication along with the plan. Additionally, I understand that sickness may occur during any time at the camp and I permit my child to participate knowing that risk.

Financials Responsibility – I will be financially responsible for the registered programs including any other fees incurred through participation. In the event that I withdraw, my child for any reason, I know that I will be held responsible for the terms and conditions set forth in this agreement. I understand that there will be no refund or credit given for missed camp days. I understand that Mr. Von Hoyningen Huene may allow for make-up days in the event of an illness. On the morning of the illness, the parent must notify Mr. Von Hoyningen Huene to report the missed day before 9:00 am. I understand that the terms and conditions set forth. By signing and initialing this agreement, I as parent or guardian, am solely responsible and in agreement with all the terms and conditions stated above, including all financial obligations, policies, procedures, and other documentation provided on this form.

By signing below, you agree that you have read and fully understand this agreement and have made a copy for my records. If English is not your first language, someone I trust has fully explained the agreement to me and all contained herein. I agree to pay all outstanding balances.

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