Camp Consent And Release Form

I hereby authorize my child’s participation in all Columbia Grammar Summer Camp activities. I recognize that the classes may require strenuous physical activity and I attest that my child is physically fit for such activity. I, as the parent, assume all the risks normal to these activities and absolve Columbia Grammar Summer Camp of all present and future liability in the event of accident or injury. In the event of an accident or sudden illness, if Columbia Grammar Summer Camp cannot reach me by phone, I authorize them to arrange for emergency medical care for my child.

Further, I irrevocably grant to Columbia Grammar Summer Camp the right to use any photograph, likeness, or image of my minor child, and/or me and my family in whole or in part, in any media, including the Internet, for promotional or other purposes provided that my minor child(ren)’s last name(s) and/or my last name and my family’s last names shall not be used to identify my minor child(ren)’s, and/or me and my family in any such photograph, likeness or image in whole or in part. I release Columbia Grammar Summer Camp from any liability in connection with such use.

If you choose to not have your child(ren)’s images used, please email

I acknowledge that I have read this Consent and Release Agreement and that it shall benefit and be binding on me, my successors, heirs and assigns.

Also, I have read and agree to abide by the following policies:

There is a non-refundable, non-transferable deposit of $500 for each application required upon registration. Full payment must be received before the first day of camp. No refunds will be issued for absences, changes, withdrawals, or terminations.  Health forms are due by Friday, May 24th. New York State requires that proof of immunization against DPT, Polio, Measles, Mumps, Hepatitis B, HIB, and Rubella be on file with the school nurse before camp begins. A record of immunization is required on the camp medical form. Campers will not be permitted to begin camp until we have received completed medical forms.

There is a $30 charge for returned checks. We assume no liability for strollers, clothing or other personal belongings left unattended.