Owens Valley Tribal Environmental Youth Camp Application - 2023

Gender: *
T-shirt Size *
Does camper have any food or other allergies? *
Is camper capable of participating in strenuous activities? *
Is camper required to take medications? *
Will camper take their medication on their own? *
If no, do you authorize camp staff to administer medication? *
Does camper have any of the following: *
Has camper had surgery in past 4 years? *
Does camper have any past injuries? *
May camper be given any of the following non-prescription medications under staff supervision? Check Selection(s) *
Is camper allowed to swim at camp? *
Please rate camper's swimming ability. *
As parent or legal guardian of camper, I have completed the above application/health history/medication consent form and understand each question.  I give full authorization to administer medication, if needed, as indicated above.
I hereby give permission to the Owens Valley Indian Water Commission and other personnel to administer First Aid/CPR and to arrange for medical care and treatment in case of a medical emergency.  As parent or legal guardian, I also give permission to the physician selected by the Owens Valley Indian Water Commission to examine, diagnose and treat, or secure proper treatment for my child, as the physician shall determine what is proper and necessary under the circumstances.  A photocopy of this authorization shall be deemed valid and accepted as the original.  My child's medical condition(s) as stated above are correct and complete.
I have been informed of the nature of the Owens Valley Indian Water Commission program in which my child is enrolled.  As parent or legal guardian, I understand there are risks associated with my child's participation in the camp activities and transportation to and from the camp, which pose a threat of injury, illness, or death.  I am familiar with outdoor sports and activities and my child's abilities and I am not aware of any physical, emotional, or mental problem or limitation that would prevent, impair, or increase the risks involved in my child's participation at the camp.  With this knowledge, as parent or legal guardian, I grant permission for my child to participate in all camp activities. 
As parent or legal guardian, I authorize camp personnel to photograph and/or video record my child for promotional and documentary purposes. 
On behalf of myself and my child, I accept and assume the risk and full responsibility for injury, illness, death or loss of personal property or other damage, and medical or other expenses resulting from my child's presence and participation at the camp.
I hereby release and discharge the Owens Valley Indian Water Commission, its Board of Directors, staff, camp personnel, and participating tribes (Bishop Paiute Tribe, Big Pine Paiute Tribe of the Owens Valley, Bridgeport Indian Colony, Fort Independence Reservation, Utu Utu Gwaitu Paiute Tribe, Timbisha Shoshone Tribe, and any other participating Tribes) from liability to me and to my child of any and all losses, damages, expenses, and any injury to person, including death, resulting from my child's participation in the camp/program and travel to or from camp sites and activity locations.
As parent or legal guardian, I agree to direct my child to comply with all camp rules and policies and to cooperate with camp personnel.  As parent or legal guardian, I understand that if my child fails to comply with the rules and policies, he/she may be expelled from the camp and sent home at my expense.
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