This field is for validation purposes and should be left unchanged.

Date of Birth(Required)

Parent/Guardian Information

Relationship to Camper(Required)

Additional Parent/Guardian Information

Relationship to Camper(Required)

Emergency Contact Information

Relationship to camper(Required)

Allergy & Medical Information

Describe your camper's allergies and any care instructions(Required)

Provide medication details and instructions(Required)

Please Explain(Required)

Camper's primary physician(Required)

Physician's Phone Number(Required)

Self-Release/Pick-up Authorization

Photo identification will be required before campers will be released.

Additional Authorized Pick-Up Person

Parents and guardians will automatically be allowed to pick up. Please add any additional authorized persons.

California Historical Radio Society (CHRS) Children’s Camp Liability Waiver and Release of Claims

1. Acknowledgment of Risk

I, the parent or legal guardian of the above-named child (“Participant”), understand and acknowledge that participation in the CHRS Camp involves activities that may expose the Participant to certain risks. These activities may include, but are not limited to:

Hands-on interaction with vintage electronic equipment, tools, and radios
Demonstrations and supervised activities involving electrical circuits and soldering
Exposure to low-voltage power sources and old electrical components
Use of hand tools, sharp objects, and mechanical parts
Movement throughout a historic facility, which may include uneven surfaces, stairs, or outdoor areas
Potential exposure to dust, mild chemicals (e.g., cleaning solvents), or other substances present in a workshop environment
Participation in indoor and outdoor activities that may involve heat, sun exposure, or minor environmental hazards

What other information would be useful for us to know about your camper?

Name