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 2025 Hume All Minor Releases

ACTIVITIES PARTICIPATION RELEASE

WHILE HUME MAKES EVERY EFFORT TO PROVIDE A SAFE AND PLEASANT ENVIRONMENT FOR YOU AND/OR YOUR MINOR CHILD, WE DO REQUIRE THAT THIS PARTICIPATION AGREEMENT BE READ, COMPLETED, SIGNED AND DATED BY THE ADULT PARTICIPANT OR PARENT/LEGAL GUARDIAN OF EACH CHILD UNDER 18 YEARS OF AGE WHO WILL POTENTIALLY PARTICIPATE IN THE ACTIVITIES WHICH OCCUR AT OR AROUND HUME LAKE CHRISTIAN CAMPS, OR AT ANY OF THE CAMPS OR AT ANY OF THE CAMP’S OFF-SITE LOCATIONS.

I, the undersigned, acknowledge my potential participation in, and/or give permission for my minor child to participate in, the activities that occur at or around Hume Lake Christian Camps, Hume Lake, or at or about any of the Camp’s off-site locations. These activities include, but are not limited to, swimming in the pools, ponds and Lake; boating; High Ropes Courses, Zip Lines and Rappelling; biking and Bike Jump; archery; shooting; paintball; swings and playground equipment; skating; snowboarding; snow tubing; strenuous competition games; and Free-time activities of choice. Adult activities may further include, but are not limited to, off-site 4x4 vehicle and motorcycle tours; off-site bike tours; and golf cart usage. I accept my participation, and/or grant this permission for my minor child, with full knowledge that I accept full responsibility for any injury or accident that may occur.

Hume Lake Christian Camps has taken reasonable steps to provide equipment and skilled employees so you and/or your child can participate in activities which might be new or challenging. However, we now remind you that these activities are not without risk. Certain risks cannot be eliminated due to the Camp’s varied settings and without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be cause of loss or damage to your property, accidental injury or illness, or, in extreme cases, permanent trauma or death. We do not want to frighten you or reduce your enthusiasm for these activities, but we do think it is important for you to be informed and know in advance about inherent risks.

In recognition and acceptance of the above risks, I, on behalf of myself, my children, my assigns and my estate, agree to release and hold harmless Hume Lake Christian Camps, Inc., its officers, Board, agents or employees, for any and all claims for injuries, causes of action, or liability related to my and or my minor child's participation in any activity occurring at Hume Lake Christian Camps, on or around Hume Lake, and at or about any of the Camp’s off-site locations. This release does not apply to intentional and/or willful acts of misconduct by Hume Lake Christian Camps or any of its officers, Board, agents or employees. 

Should Hume Lake Christian Camps, or anyone acting on their behalf, be required to incur attorneys’ fees and costs to defend a claim or lawsuit, or to enforce this agreement, I agree to indemnify and hold Hume Lake Christian Camps harmless for all such fees and costs. For promotional or marketing purposes, Hume Lake Christian Camps reserves the right to use any audio, video, and/or photography of guests or campers participating in Hume- facilitated events.

By signing this document, I acknowledge that if anyone is hurt or property damaged during my or my minor child's participation in these activities, I and or my minor child may be found by a court of law to have waived any right to maintain a claim or lawsuit against Hume Lake Christian Camps on the basis of any claim which has been released herein. I have had sufficient opportunity to read this entire document, have read and understood it, and agree to be bound by its terms. 

October 28, 2025

PHOTGRAPH, RECORDING, & MEDIA CONSENT

IN CONSIDERATION of the privilege of my and/or the minor's (defined later) use of Hume’s facilities and participation in Hume’s programs or activities on Hume properties, the undersigned individual states as follows (all references to Hume shall include all activities conducted by Hume (i) at the Hume Lake Christian Camps location in Hume, California, (ii) throughout the State of California, (iii) at or near the Hume Lake New England camp location in Monterey, Massachusetts, and (iv) at or near the Hume Hawaii camp locations in Waialua, Hawaii and Waimea, Hawaii.)

MINOR DEFINED: For purposes of this Photo Release, “Minor” is defined as a minor child in the broadest possible sense over which the Adult signing this Release has legal authority and responsibility. This may include but is not limited to, the adult’s child by natural-birth, child by legal adoption, child by foster care, child by marriage (step-child), legal ward, juvenile, conservatee, and/or any other relationship whereby an adult accepts legal responsibility for a minor. By signing this Release on behalf of a Minor, I hereby represent I have legal authority to sign on behalf of the Minor identified herein.

PHOTO AND RECORDING ACKNOWLEDGEMENT: I ACKNOWLEDGE that Hume may take photographs or film or digital recording of me, the Minor, and other participants during Program activities, and I hereby authorize Hume and its agents to take, use, display, publish, reproduce, and distribute any and all photographs and recordings that include my and/or the Minor’s image and to create derivative works based upon all such photographs and recordings, including use in media releases, reports on the findings of the Program, marketing and promotional materials, newsletters, and websites, social media, and electronic communications.

MISCELLANEOUS: If any provision of this document is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this document had been executed with the invalid provision eliminated, and such invalid provision may be modified by a judicial tribunal (including an arbitrator) to make such provision enforceable consistent with the parties’ intent in entering into this document. I understand and agree that this document is intended to be as broad and inclusive as permitted under applicable law, and that this document provides the broadest release and waiver of claims as permitted under applicable law.

October 28, 2025

RELEASE OF LIABILITY & ASSUMPTION OF RISK

Hume Lake Christian Camps, Inc. (‘‘Hume”)

RELEASE OF LIABILITY AND ASSUMPTION OF RISK (“Release”)

PLEASE READ CAREFULLY. BY SIGNING BELOW, YOU ARE AGREEING ON BEHALF OF THE MINOR AND ON YOUR OWN BEHALF TO RELEASE HUME AND OTHER PARTIES RELATED TO IT FROM LIABILITY.

IN CONSIDERATION of the privilege of the Minor’s (defined later) use of Hume’s facilities and participation in Hume’s programs, the undersigned individual states as follows (all references to Hume shall include all activities conducted by Hume (i) at the Hume Lake location in Hume, California, (ii) throughout the State of California, and (iii) at or near the Hume New England camp location in Monterey, Massachusetts.

MINOR DEFINED: For purposes of this Release, “Minor” is defined as a minor child in the broadest possible sense over which the Adult signing this Release has legal authority and responsibility. This may include but is not limited to, the adult’s child by natural-birth, child by legal adoption, child by foster care, child by marriage (step-child), legal ward, juvenile, conservatee, and/or any other relationship whereby an adult accepts legal responsibility for a minor. By signing this Release on behalf of a Minor, I hereby represent I have legal authority to sign on behalf of the Minor identified herein.

ASSUMPTION OF RISK: Hume intends to make me aware, and I understand, that use of Hume’s facilities, volunteering to assist Hume at Hume facilities or on Hume’s behalf at Hume sponsored events, and participation in Hume’s programs, including, but not limited to, swimming in pools, ponds and lakes; boating; high ropes courses, zip lines and rappelling; biking and bike jumping; archery; shooting; paintball; use of swings and playground equipment; skating; snowboarding; snow tubing; strenuous competition games and physical activity in natural environments; free-time activities of choice; mountain and wilderness travel; transportation to and from Hume and to and from camp trips/activities; crafts; rock scrambling and technical rock climbing; off-site 4x4 vehicle and motorcycle tours; off-site bike tours; and golf cart usage (the “Program”), exposes the participant to certain risks, hazards, and dangers, including, by way of example, the risk of personal injury (including the risk of permanent disability or death), accidents or illnesses in remote places (without the immediate availability of medical facilities); vehicle accidents; exposure to adverse weather conditions and wildlife; exposure to biting insects and wildlife, including insects and wildlife that may carry disease; malfunctioning equipment such as helmets, life jackets, harnesses, ropes, cables and any equipment provided by Hume related to any of the above-described activities; malfunctioning camp facilities; slippery and/or uneven surfaces; open, natural water conditions with varying depths and currents; and exposure to infectious sicknesses and diseases, epidemics and pandemics, including COVID-19 (collectively, the “Inherent Risks”). There may be other risks, which may not be known by me, or predicted and controlled by the Program, and which could result not only in physical, mental, or emotional injury but in social, economic, or other kinds of losses either not known to me or not foreseeable at this time and I acknowledge these are included within the Inherent Risks. The Inherent Risks may be caused by my and/or the Minor’s own actions or inactions, the actions of others, the conditions in which the Program takes place, or the negligence of the “Released Parties” named below. I also understand that outdoor, recreational and adventure activities require physical exertion, and any participant should be in good physical health. I further understand it is my responsibility to provide adequate clothing for the Minor to participate. If the Minor is not in good health, I realize this may create additional risk. ON BEHALF OF THE MINOR AND ME, I FULLY AND VOLUNTARILY ACCEPT AND ASSUME ALL SUCH INHERENT RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred by me as a result of my participation in the Program, while using Hume facilities, or while volunteering to assist Hume at Hume facilities or on Hume’s behalf at Hume sponsored events.

RELEASE - MINOR’S RIGHTS:

I AM SIGNING THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK ON BEHALF OF A MINOR, I HEREBY RELEASE, DISCHARGE, AND AGREE NOT TO SUE Hume, and any of its directors, agents, officers, affiliates, volunteers and employees, and sponsors and vendors, and other participants in the Program (collectively, the “Released Parties”), and each of them, of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that the Minor may have or sustain, including attorneys’ fees and costs, with respect to any and all property damage, economic loss, medical expense, personal injury, and other expense, injury, or harm and/or death arising directly or indirectly out of the Minor’s participation in the Program, including without limitation any and all of those Inherent Risks described above. The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages, and liabilities, including but not limited to claims for negligence, loss of consortium and wrongful death, but excepting claims related to gross negligence, intentional and/or willful acts of misconduct.

RELEASE - ADULT AND/OR PARENTS’/GUARDIANS’ RIGHTS:

I HEREBY RELEASE, DISCHARGE, AND AGREE NOT TO SUE the Released Parties, and each of them, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that I as a participant and/or as the parent/guardian of the Minor may have or sustain, including attorneys’ fees and costs, with respect to any and all property damage, economic loss, medical expense, personal injury, and other expense, injury, or harm, and/or death arising directly or indirectly from the participation of the Minor in the Program, including without limitation any and all of those Inherent Risks described above.

The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages, and liabilities, including but not limited to claims for negligence, loss of consortium and wrongful death, but excepting claims related to gross negligence, intentional and/or willful acts of misconduct.

APPLICATION OF COVENANTS AND UNDERSTANDINGS: The covenants and undertakings of this Release are given for and shall be binding upon my and the Minor’s family, heirs, estate, next of kin, executors, administrators, legal representatives, beneficiaries, successors, and assigns.

INDEMNIFICATION: I FURTHER AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS the Released Parties, and each of them, from and against any and all claims, demands, losses, damages, attorneys’ fees and costs, expenses, and liabilities made against or incurred by any of them, including those for indemnity, contribution, or otherwise, arising from my and/or the Minor’s participation in the Program and the Inherent Risks, whether resulting from claims, actions, or lawsuits asserted by me or by another person against the Released Parties, except to the extent prohibited by applicable law.

COMMUNICABLE DISEASE: I understand that Hume Lake strongly recommends that every registered guest and staff come to camp immunized against reasonable conditions (i.e., tetanus, influenza, chickenpox). Registered guests and staff can state they are not immunized for health reasons or personal beliefs. Further I recognize Hume’s expectation that registered guests and staff should arrive with no symptoms of communicable or infectious disease (i.e., temperature over 100.3, nausea, vomiting, or diarrhea). I also understand that should such an infectious or contagious illness present before arrival, I should contact the specific Hume location’s Health Center or appropriate camp Healthcare representative at that location to set up an appropriate control plan to minimize the potential for spread. This may include a delayed or canceled camp arrival. I understand that Hume Lake reserves the right not to admit and send home a person who arrives and poses an infectious disease risk to others. If a registered guest develops the above symptoms while attending camp, I understand that the Hume Lake Health Center staff may isolate guests until symptoms have resolved without medication for 24 hours, or they must be retrieved by the parents/guardians or registered group leadership (school, church, organization, etc.). I also understand that should an outbreak of an infectious disease occur, and the need arise to close the camp, campers or staff may be sent home early at the sole discretion of Hume. Finally, I understand that in both individual and outbreak situations, the parents/guardians or registered group leadership (school, church, organization, etc.) must retrieve their camper or arrange for appropriate transportation from Hume as soon as possible.

LODGING & ACTIVITY RULES: Hume has designated lodging and facilities, as well as certain activities and events, to be gender specific. Hume has adopted a policy that a participant’s gender is the gender assigned to him or her at birth based on their biological sex at birth. All participants are required to use the lodging and facilities and participate only in activities and events designated for the participant’s gender, based on Hume’s position on gender and is consistent with Hume’s statement of faith.

MISCELLANEOUS: If any provision of this document is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this document had been executed with the invalid provision eliminated, and such invalid provision may be modified by a judicial tribunal (including an arbitrator) to make such provision enforceable consistent with the parties’ intent in entering into this document. I understand and agree that this document is intended to be as broad and inclusive as permitted under applicable law, and that this document provides the broadest release and waiver of claims as permitted under applicable law.

BY SIGNING BELOW, EACH UNDERSIGNED PARENT/GUARDIAN OF THE MINOR PARTICIPANT ATTESTS AS FOLLOWS: I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY; 

I HAVE LEGAL RESPONSIBILITY OVER THE MINOR PARTICIPANT, AND, IF I AM THE SOLE PARENT/GUARDIAN SIGNING BELOW, MY SIGNATURE IS SUFFICIENT TO ENTER INTO THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK FOR AND ON BEHALF OF THE MINOR; AND I HAVE HAD THE OPPORTUNITY TO REVIEW THIS DOCUMENT WITH LEGAL COUNSEL, IF I WISH, BEFORE SIGNING BELOW.

October 28, 2025


First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Third Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Age:

Camp/Event/Reason for Stay:
Date(s) of Stay:

HEALTH HISTORY


Allergies

Medical/Surgical history:
Date of last tetanus shot:

Name, dosage, frequency, and reason for any medications that must be taken regularly, or as needed:
Should your child require medical attention at camp for injuries received or illnesses contracted prior to attending camp, please provide us the information necessary to provide them with proper medical attention during their stay.

Hume’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury during your child’s stay at Hume.

Do you have health insurance?*
No
Yes
MEDICAL RELEASE: In the event I can’t be reached in an emergency during the camp dates shown on this form, I hereby give permission to the physician or dentist selected by Hume to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I also authorize the nurse/EMT on duty at Hume to administer medical aid as required for illness or injury under a physician’s orders. The signature of the parent or guardian below is intended to serve as a medical release. This form may be copied and given to the counselor if there’s information pertinent to the care of your child. If there’s a reason that you wish this information stay confidential, please contact our Hume office.*
Yes
No
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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