Summer Campout

Participant Information

Participant Name

First Name

Last Name

Age

Parent/Guardian Name (if under 18)

First Name

Last Name

Relationship to Camper

Phone Number

Email

Home Address

City

State/Province

Zip/Postal

Emergency Contact

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone

Medical Information

Does the participant have any allergies, medical conditions, or dietary restrictions?

Yes

No

If you selected yes, please Specify allergies, medical conditions, or dietary restrictions?

Does the participant require any medication during the event?

Yes

No

If you selected yes, please Specify Medications Needed During the Event

Primary Physician

Primary Physician Phone Number

Will you be bringing a tent?

Yes

No

Unfortunately we are not able to provide tents

Do you have any special needs or requests?

No

Yes

If you selected yes, please specify needs or requests?

Do you have any food restrictions for the provided meals?

No

Yes

If you selected yes, please specify food restrictions for the provided meals

Waiver & Consent

I, the undersigned, permit myself/my child to participate in the Wayne County Sheriff's Youth Safe Summer Camp Out at Detroit Riverside Marina from July 18 to July 20, 2025. I understand that outdoor activities involve some risk, and I assume all responsibility for myself/my child.

I acknowledge that photos/videos and consent to their use may be taken for promotional purposes.

I hereby release the Wayne County Sheriff's Youth & Senior Education Fund, its officers, employees, and volunteers from any liability for injuries or damage sustained while attending the event.

Signature (Parent/Guardian if under 18)

Clear

Printed Name

Date

Annual WCSYSEF Safe Summer Camp Out Registration Form

Wayne County Sheriff Connect