Child Information FormTel: +41 79 541 13 63Email: info@connectsummercamps.com www.connectsummercamps.com Child Information Childs Name * First Name Last Name Childs Date of Birth * What languages does your child speak/understand? * Campers Sex Male Female Skiing Ability (for winter groups only) Please select which description best fits your child's skiing ability: Beginner - has never skied before Blue Run Adventurers - your child can ski in a snowplough on easy blue runs outside of the beginner park Red Run Explorers - your child can ski in plough-parallel (sometimes parallel) on red runs and is comfortable on chairlifts Black Run Rovers - your child can ski in parallel and is comfortable on black runs Teen Slopestyle - your teenager can ski the whole mountain and would like to work on skills in the terrain park Other Notes on skiing ability Please share any other relevant information about your childs skiing ability that will help us decide which group to start them in. Dietary Requirements Vegetarian / Vegan / Nut Allergy etc. Parent/Guardian Information Guardian 1 of Campers Name First Name Last Name Guardian 2 of Campers Name First Name Last Name Email Address Mobile Emergency Number * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Insurance Information Please indicate below your Child's accident/illness insurance: Policy Name and Number We would only require this information should your child require medical assistance and we cannot get hold of the parent. We will always contact the parents in the first instance. Health History Does your child have a history of any of the following? Diabetes Yes No Seizures/Fits Yes No Asthma Yes No Ear Problems Yes No Stomach Upsets Yes No Other Allergies Does your child suffer from allergic reactions? If yes, please provide information about treatment and doses. For instance, does your child carry and EpiPen? Is your child taking any medication? Yes No If yes, what medication are they currently taking? Are there any aspects of your child's health, which would prevent them participating fully in activities? Are there any other medical, social or emotional considerations the instructor should know about? Parent's or Guardian's Declaration The information I have given above is correct to the best of my knowledge, and the child named above has my permission to participate in all activities, unless otherwise noted and indicated. I hereby give permission to the Connect Summer Camp staff to request treatment by a doctor for the above named child if necessary. In an emergency, if I cannot be contacted, I also give permission for the physician(s) selected by Connect Summer Camp to hospitalise, order X-rays, medications, anesthesia, surgery or any other treatment considered necessary for the above named child, unless otherwise noted. I have read and understood the contents of this form as well as the Booking Conditions and agree to all policies stated therein. Signature * Date/Place * There will be some photos taken and a daily update at our facebook and web page. The Photos might also be used for marketing purposes. In order to do this, we need your permission below. Photos will be distributed very carefully. I accept that Connect Summer Camp can very carefully use any photograph or video in which the above named participant(s) appears while participating in any activity associated with Connect Experiences. Thank you!
