Child's Name*

First Last

Child's Birthdate*

Please list any other campers your child will be carpooling with:

Please list any allergies:

Will you be sending your child with an inhaler or an Epipen?*

Yes
No

Does your camper need any accommodations?

No
Yes

If yes, please specify

Sign language interpreter
Assistive listening system
Large print or digital versions of documents
Additional assistance with instructions or processing information
Other

If other, please specify

*If you answered yes, a staff member will contact you for more information. The accommodations listed are available by request with advanced notice based on availability.

We do not have the staffing capacity or expertise to assist with toileting. If a camper has a personal care assistant or family member to help with toileting-related needs, that person can attend the camp at no cost.

Only authorized persons will be allowed for camp pick up and proof of identification must be provided each day. Please list who is authorized to pick up your camper and a phone number for each person:*

If you have any questions contact [email protected].

Liability Waiver, Emergency Medical Authorization and Photography Permission

I understand and appreciate that participation in the Project Connect and Crystal Bridges Museum of American Art (“the Museums”) children’s program involves potential, although highly unlikely, loss or damage to personal property and bodily injury, and I hereby assume all of said risks for myself and my child. In consideration of the use and availability of the services and facilities involved in the program by me and my child, I hereby agree to the extent allowed by law to release, relieve, hold harmless and indemnify the Museums and their respective officers, agents, instructors, employees and sponsors from all liability claims arising out of any accident or injury suffered or incurred by me or my child while participating in the Museums program.

In case of accident, injury or sudden illness, I hereby grant permission for my child to receive all appropriate first aid or emergency medical care necessary, and authorize that my child may be transported to a local medical facility.

I give permission for Project Connect, Crystal Bridges, and their respective officers, agents, instructors, employees and sponsors to use, without limitation or obligations, photographs, video and/or audio recordings which may include my child’s image, voice or artwork for purposes of promotional or educational purposes.

*

I have read and hereby agree and consent to this Liability Waiver, Emergency Medical Authorization and Photography Permission.

Parent / Legal Guardian Name*

Camp Connect at Crystal Bridges Liability Waiver

Liability Waiver, Emergency Medical Authorization and Photography Permission