• CAMP NICK REGISTRATION

    CAMP NICK REGISTRATION

  • Camper Information

    All information provided on this form is confidential
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  • Medical/Insurance Information

  • Medical Treatment

    In the event I cannot be reached to make arrangements for emergency medical attention, I authorize St. Luke's staff members or authorized counselors to obtain emergency medical treatment in case of illness or injury to the participant named above.

  • Photo Release

    I grant permission for Nick Finnegan Counseling Center, it's staff and authorized volunteers, to take photographs and/or video of my child while participating in programs and/or events, and to publish the same (name withheld) in print, electronic and/or broadcast media, for promotional and informational purposes.

  • Parent/Guardian Information

    Also referred to as Client Representative for minors
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  • Emergency Contact Information

    NFCC will contact this person if there is an emergency situation during camp and we are not able to reach the parent/guardian listed above.

  • Authorization for Treatment

    I agree that I have been given appropriate opportunity to address any questions or request clarification for anything that is unclear to me.
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