Clone of WORX Project Registration 2026 Week 2 July 13-16

Buncombe County or Asheville City School Attending*

This program is for rising 6th, 7th, and 8th graders attending a public middle school in Buncombe County or Asheville City and ACS IRL rising 9th graders. This is inclusive of charter schools as well.

Notes

Name*

First NameLast Name

Grade Attendee Enters Next School Year*

School attending in Fall of 2026*

Attendee Date of Birth*

MonthDayYear

Age at Start of Program*

FemaleMaleNonbinaryPrefer not to answer

YesNoUnsure

YesNoUnsurePrefer not to answer

Parent Name*

First NameLast Name

Primary Parent Phone Number*

Parent Email*

Confirmation Email

Parent Name

First NameLast Name

Parent Phone

Format: (000) 000-0000.

Parent E-mail*

Confirmation EmailLeave blank if you do not want us to use a second email

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact (other than parent)*

First NameLast Name

Your Emergency Contact's Phone Number*

Format: (000) 000-0000.

Date of child's last tetanus shot*

Please explain any checked allergies and if the attendee carries medication with them for any of these allergies.

Please check "yes" or "no" to let us know if any of these apply to your child.*

Rows	Yes	No
Asthma
Heart Conditions
Measles
Diabetes
Ear Infections
Chronic or recurring illnesses
Operations or serious injuries
Head Trauma
Seizures
Other

If yes to any of the above please explain.

Please list any special needs or medications your child is currently taking.

VegetarianVeganFood AllergiesOther

Please explain any food allergies.

Please let us know of any other dietary considerations or preferences.

Please check "yes" or "no" to let us know if it is okay to give the following over the counter medications, treatments, or prevention items that we keep on hand to your child. *

Rows	Yes	No
Ibuprofen (Advil)
Acetaminophen (Tylenol)
Diphenhydramine (Benadryl)
Anti-itch Cream (Cortisone)
Sunscreen
Bug Spray

Does the camper have any learning, physical, or developmental needs we should be aware of to ensure full participation? (Optional)

Please describe any other issues you feel we need to know to provide for your child's health and safety. (Optional)

CONSENT FOR EMERGENCY MEDICAL TREATMENT I do hereby authorize the Camp Grier Director or such substitute as he may designate as our agent to consent to emergency medical treatment and hospital care for the above minor. Such treatment must be deemed advisable by and rendered under the general or special supervision of any physician or surgeon licensed under the provision of the Medicine Practice Act or any dentist licensed under the Dentist Practice Act. This diagnosis or treatment may be rendered at the office of said physician or dentist, at a hospital, wilderness setting or elsewhere. Parent/ Guardian Initials:*

Date*

GENERAL LIABILITY WAIVER AND RELEASE: Camp and adventure activities including, but not limited to, rock climbing, rappelling, hiking, biking, and wilderness travel, in general, have inherent risks. This document is an acknowledgment of those inherent risks. I recognize that good health is important to participate in activities at Camp Grier. I certify that I am in good health and have no physical or mental conditions which would endanger myself or others. I agree to consult a physician before engaging in any activity with an employee of Camp Grier if I have any doubt whatsoever about my physical or mental condition.

ACKNOWLEDGMENT OF RISKS: This document is an acknowledgment of those inherent risks which could result in injury, death, illness, disease, and damage to me or to my property and to others and their property. I voluntarily assume all known or unknown risks of participating in an outing led by Camp Grier. I am aware that those risks include, but are not limited to, risk of injury, paralysis, or death from falling, failure of equipment, reliance on others to belay, failure of anchors, holds or rock or ice fall, and my own or other’s failure to follow proper procedures, instructions of the guide, and use sound judgment. The above list is not complete or exhaustive and other risks known or unknown may also result in injury, death, illness, disease, and damage to me or to my property and to others and their property. I understand these risks and voluntarily assume all risks associated with this activity. By coming to Camp Grier I am voluntarily assuming all risks related to exposure to COVID-19 and any other communicable disease.

RELEASE, INDEMNIFICATION AND COVENANT NOT TO SUE: In consideration of hiring Camp Grier, I on behalf of myself, my heirs, legal representatives, and assigns hereby voluntarily release and covenant not to sue Camp Grier, its officers, agents, employees, owners, successors and assigns, from any cause of action, claim or demand of any nature whatsoever which relate to or arise out of my participation in a Camp Grier outing, clinic, or trip, including but not limited to the negligence of Camp Grier, its officers, agents, employees or owners. I also agree to indemnify and hold harmless Camp Grier, its officers, employees, owners and agents from any and all causes of action, demands, losses or costs (including attorney’s fees) of any nature which arise out of my participation in any outing, activity, or trip.

AGREEMENT TO FOLLOW SAFETY GUIDELINES: I accept full responsibility for my safety and the safety of others. I agree to abide by and help enforce the safety guidelines of any Camp Grier counselor or instructor and recognize that not all risks will be evident to a Camp Grier counselor or Instructor.

GENERAL: Camp Grier shall have the right to restrict or deny my participation in any activity or trip, restrict my access to certain terrain, and to exclude me from further participation at any time and for any reason. I further recognize that no representations or guarantees are being made to me by Camp Grier as to my own proficiencies, levels, attainment or my abilities to engage in similar activities without suffering injury or death in the future.

PHOTO RELEASE: I give permission for photographs and videos to be taken of my child while participating in Camp Grier Activities. I agree to allow these photographs and videos to be used in marketing/public relations materials and in the promotion of Camp Grier and WORX Project partners.

I HAVE CAREFULLY READ THIS FORM AND FULLY UNDERSTAND ITS CONTENTS. I UNDERSTAND THAT I HAVE GIVEN UP CERTAIN LEGAL RIGHTS AND THAT THIS IS A BINDING LEGAL DOCUMENT.

Attendee Initials.*

Parent/ Guardian Initials.*

I give my child permission to travel in vehicles with Camp Grier staff to locations off campus as necessary.

Parent/ Guardian Initials.*

Please list all people who have permission to pick up your child.*

Parent/ Guardian Initials.*

Donation

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parent/Guardian Full Name if participant is under 18 years of age.

First NameLast Name

E-Signature of parent for participant under 18 years of age. Click and hold down left mouse button to sign.

Date

WEEK ONE REGISTRATION

Program Registration

Attendee Information:

Optional Demographic Information:

PARENT Information:

Health and Medical Information

Liability and Waivers

Permission to Travel

Permission to Pick Up

Suggested Donation

Parent/Guardian Signature