Bard Music Camp 2022 - Medical Release Form
Bard Music Camp 2022 - Medical Release Form
* Indicates required field
MEDICAL INFORMATION
Child #1 Full Name
Child #1 Full Name
*
First
Last
Child #1 Date of Birth
Child #1 Date of Birth
*
/
MM
/
DD
YYYY
Child #1: Allergies (no food is to be provided by Bard Music Camp):
Child #1: Other Pertinent Medical Information:
Child #2 Full Name
Child #2 Full Name
First
Last
Child #2 Date of Birth
Child #2 Date of Birth
/
MM
/
DD
YYYY
Child #2: Allergies (no food is to be provided by Bard Music Camp):
Child #2: Other Pertinent Medical Information:
Child #3 Full Name
Child #3 Full Name
First
Last
Child #3 Date of Birth
Child #3 Date of Birth
/
MM
/
DD
YYYY
Child #3: Allergies (no food is to be provided by Bard Music Camp):
Child #3: Other Pertinent Medical Information:
All campers MUST be fully vaccinated for COVID-19 in order to participate at Bard Music Camp.
Please check ONE:
*
All campers MUST be fully vaccinated for COVID-19 in order to participate at Bard Music Camp.
Please check ONE:
Bard Prep Students Only: Vaccine card has been submitted previously
Vaccine card will be uploaded below:
My child is under 5 and not yet eligible for the vaccine.
Please upload each child's vaccine card (multiple cards may be uploaded here):
Attach Files
PARENT'S NAME
PARENT'S NAME
*
First
Last
PARENT'S EMAIL
*
First Choice Parent/Guardian Name and Number:
*
Emergency Contact Name (in case parents cannot be reached):
*
Emergency Contact Phone Number
Emergency Contact Phone Number
*
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Primary Care Physician Name:
Primary Care Physician Phone Number:
Primary Care Physician Phone Number:
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Please read and check (required):
*
Please read and check (required):
I hereby authorize (his or her) participation in the Bard Music Camp at Bard College for July 2022. I further release Bard College, its directors, officers, employees, students, agents, representatives or affiliates, from any and all liability caused in whole or in part by anyone affiliated with Bard College or from any other cause whatsoever, which results in bodily injury or personal injury suffered by above named minor participant and for any loss or loss of use or damage to personal property owned by said participant or family member, or any other damage or injury, which may result due to the above named minor’s visit or use of Bard College facilities during this activity. I further understand that all Bard College employees including faculty, staff and volunteers involved in said visitation will exercise reasonable care and act responsibly while conducting activities of said visitation. I further understand that Bard College does not provide Health Insurance for students during their participation in the Bard Music Camp. Health Insurance is the sole responsibility of the child’s parent(s) or guardian(s).
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