Your Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Your Phone Number

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone *

(###)

###

####

I am committed to serve as a beaver at Ambassador 2025. I am committed and will be there at the appointed time + date. *

I Agree

Medical Authorization

I, the parent or legal guardian of the person listed on this form, certify that she has my full approval to participate in Camp Warsaw

yes

no

Further, I release and hereby agree to hold blameless(harmless) Camp Warsaw and its directors, staff and agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with Camp Warsaw

yes

no

I hereby release Ambassador Girls Camp and its leaders from any liability for accident or injury during this camp. Consent for medical treatment of minors separated from their Parents or Legal Guardian. Time Period July 21 st. - 25th,2025

yes

no