Camp HIS KIDS HK@Home Fully Interactive Virtual Camp Sign-Up 

NOTE: You must complete a separate application for each child who wants to participate.

Which camp section is your child applying for? 

Has this child attended Camp HIS KIDS in the past?
Treatment Status
T-shirt Size

If the child splits time between 2 households and you want to provide the second household address, please use the space below. 

Sibling Information 

We will be sending alerts, updates, and reminders during the HK@Home program. Please list any email addresses, including the camper if you wish, to receive these alerts.

Please list any phone numbers below, including the camper's number if you wish, to receive these alerts, messages, and reminders via text. Please also include names with phone #s. 

Liability & Publicity Release 

I/We hereby affirm that I/we have been well advised and thoroughly informed of the inherent and potential dangers of participation in Camp HIS KIDS 2020. By signing this release, I/we certify that I/we am/are cognizant of those basic risks and dangers. I/We understand and agree that neither the following agencies, organizations, or institutions and/or their sponsors; HIS KIDS Cancer Support, Camp HIS KIDS, nor their officers, servants, agents, employees or volunteers may be held liable in any way for any occurrence in connection with a H.I.S. K.I.D.S., Inc. sponsored/ directed event which may result in injury, death, or other damages to myself or a member of my family. I/We hereby personally assume all risks in the connections with said program/event, transportation, or use of materials, buildings and environment, for any harm, injury of damage which may befall myself or a member of my family, while participating in the said program/event including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said program/event and persons from any claim by me, or my family, estate, heirs, or assigns arising out of my enrollment and participation in said program.

 

PUBLICITY

 I/We, give consent and permission for HIS KIDS Cancer Support and Camp HIS KIDS to use or authorize the use of any photos, interviews, or other publicity related items.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE PLACING MY SIGNATURE.

 

I/We hereby give permission for the child named above to attend & participate in functions & events connected with, sponsored and/or directed by HIS KIDS Cancer Support and Camp HIS KIDS

Your Signature

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Ph: (618) 654-4020- St. Louis

  (941) 302-8412-Florida

Fax: (618) 654 4499

PO Box 412, Highland, IL 62249, USA