Man Camp Liability Form

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A parent or guardian is required to fill out this form for every child who attends Man Camp. Once this form has been filled out, it does not need to be filled out again, unless your information has changed.

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Child's Name
Parent/Guardian Name
Emergency Contact Name
Name of Child's Primary Physician
Rules of Behavior

The overseeing Leader is responsible for maintaining such behavior in the group, and has authority to direct offenders to be picked up by their parent/guardian. The parent/guardian will bear all expenses for picking up their child.

Behavior that is not tolerated includes, but may not be limited to:

- Fighting, harassment, continued coarse speech or behavior

- Possession of any weapon or dangerous object

- Possession of tobacco, alcohol, or controlled substances

- No one is to stray from the group. In the event that someone becomes separated by accident, they must make every effort to immediately rejoin the group.

- Respect for and compliance for event/facility rules

*Safe and moral conduct is mandatory for every participant at every event.
Medical Consent

As the Parent/Legal Guardian of (child listed above), I authorize Broken Halos Haven, into whose care the minor has been entrusted, to consent to medical or dental treatment and/or care. It is understood that this authorization is given in advance of any specific diagnosis or treatment being required, and is given to provide authority and power to render care which the aforementioned physician, in his or her best judgment may deem advisable.

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