Number of Campers *

1

+1

Parent/ Guardian Name *

First Name

Last Name

Parent/ Guardian Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Photo Release *

I give permission to Hesed House of Wharton to use photographs, film footage, or tape recordings, which may include my or my child's image or voice, for purposes of promoting Hesed House of Wharton programs for no compensation. 

I Agree

I do not agree to have my child photographed

Liability *

As the parent/legal guardian of the above named child/children , I understand that participation in Hesed House of Wharton’s camp activities involves inherent risks. On behalf of myself and my child/children, I hereby release, waive, and discharge Hesed House of Wharton, its directors, staff, volunteers, and affiliates from any and all claims, injuries, illnesses, or damages arising from my child’s participation in camp activities, except in cases of gross negligence or willful misconduct. I acknowledge that this waiver is intended to be as broad as permitted under Texas law. By checking below, I confirm that I have read, understand, and agree to this release.

I Agree