Your Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone, incase of emergency *

(###)

###

####

Medications / Vitamins

To ensure the well-being of all campers, we have a few guidelines regarding medication. If your daughter needs to take any medication or vitamins while at camp, please ensure they are organized in a pill box with the correct dosage clearly indicated for each day and time. Kindly refrain from sending over-the-counter pain relievers like Tylenol, as we have an ample supply available if needed. For safety reasons, campers are not permitted to keep any medications, vitamins, herbs, or sleep aids in the dorms. All such items must be stored securely in the nurse's office. Additionally, if your daughter has any disabilities or health concerns, we kindly request that you provide us with detailed information when submitting the application. We are delighted to welcome all campers and want to be well-prepared to support your daughter so she can have a wonderful experience. Please inform us of any health issues as early as possible and do not wait until the week of camp. Thank you for your cooperation and understanding.

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 21st. - 25th, 2025

yes

no

Applications are first come first serve. Registration closes June 17th, or when we are full. *

Acceptance letters will be sent out the week of June 12th

I understand.