Staff Member Consent Form

Contact Information

Camp Wamp Consent Form


In consideration of the permission granted by Stephen J. Wampler Foundation Inc. (Camp Wamp) for the above named staff member to participate in activities at camp the undersigned hereby agrees to release and discharge the organization, its officers, agents and employees from all claims, demands, actions or causes of action, which I, or my personal representatives, heir and next of kin, may or might have against Camp Wamp, its Board of Directors, agents and employees on account of injury to or death of myself, or damage to the property of myself arising out of my participation in activities at camp. The undersigned further agrees to indemnify and hold harmless Camp Wamp from any loss, liability, damage or costs that may be incurred due to the acts of myself during the my participation in activities at camp. 


The undersigned does hereby give consent to Camp Wamp to collect media of the above named staff member and, without limitation, to use such pictures, videos, audio, written testimonials, stories, and any other media forms in connection with any of the work of said Camp Wamp without consideration of compensation of any kind, and does hereby release Camp Wamp from any claims whatsoever which may arise in said regard. 


In the event that an emergency should arise while the above named staff member is at camp, going to, or returning therefrom, requiring medical or surgical care or treatment, the undersigned authorizes camp staff and Camp Wamp to select and designate nurses, physicians, and surgeons to furnish such medical and/or surgical care as, in the judgment of a physician and/or surgeon holding a physician's certificate issued by the Board of Medical Examiner's of the State of California, may deem needful and proper. The undersigned absolves the Camp Wamp and nurses, physicians, and surgeons selected and designated by them, from any and all liability for their acts rendered in good faith. Emergency Contact will be notified within 24 hours of any treatment sought. 


The undersigned recognizes that Camp Wamp cannot accept responsibility for the above named staff member's personal property. Lost items may be returned to the owner if found. To help eliminate losses, the undersigned has ensured that all clothing is labeled with their name and a list of belongings has been included in luggage.


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