Camper Name*

First Last

Camper Date of Birth*

Gender*

Male

Female

Ethnicity*

Age as of May 31, 2025*

Grade Completed as of May 31, 2025*

EARLY BIRD SPECIAL - RECEIVE $20.00 DISCOUNT FOR THOSE WHO REGISTER THEIR CAMPER BY APRIL 1, 2025 FOR THE FIRST SESSION OF SUMMER JUNE 2-JUNE 6. THIS DOES NOT APPLY TO OTHER SUMMER DATES.

Sessions Attending*

Payment is due at time of registration.

Camp availability is dependent on registrations.

Camp requires a minimum of 12 Campers for each Session. Camp Tyler reserves the right to cancel a session if it does not have a minimum of 12 Campers signed up.

Campers with sibling(s) registering in the same session will receive a discount of $10.00 off per sibling.

Example:

One Camper - $325.00: - 1st sibling = $315.00; - 2nd sibling = $305.00

Students are required to bring their lunch, a water bottle, personal bug spray/sunscreen and a swim towel daily. Snacks will be provided by Camp Tyler.

Campers Address*

Street Address Address Line 2 City State ZIP Code

Campers Email

Campers Phone Number

Fathers Name

First Last

Phone

Email

Mother's Name

First Last

Phone

Email

Guardian Name (If other then father or mother)

First Last

Phone

Email

Camper Pick Up Information:

Person(s) authorized to pick up camper from Camp Tyler:*

Name

Phone

Relationship to camper

Click the plus sign to add another row

Camper Health Form

Camper

Health and Emergency Information

Physicians Name*

First Last

Phone*

Medical Insurance Company*

PolicyNumber*

Policy Holder*

First Last

Hospital Preference*

Christus Mother Francis

UTHealth

Other

Medication and dosage to be taken during camp, including over the counter, non-prescription drugs. ALL Medications must be in their original container and have specific dispensing instructions. ALL medications must be turned in to the Camp Health Officer at the beginning of camp.

Medication List (add rows as-needed)*

Medication

Dosage

Time of Day

Date of Last Tetanus shot*

Allergies, recent illness, conditions, precautions, or information:*

Over The Counter (OTC) Medication Policy: Camp Tyler takes the health and safety of our campers seriously. It is our policy that any OTC medications must be provided by the parents/guardians of the camper and be accompanied by a physician’s order. Alternatively, should OTC medications be required, and you have been unable to acquire physician’s orders, you may make arrangements with our health officer to administer OTC medications to your child.

Emergency Treatment Authorization: In case of emergency, I hereby give permission for physician(s) selected by the Camp Tyler Health Officer to hospitalize, secure proper treatment for, and to order injections, anesthesia, or surgery for my child. As parent or legal guardian of the applicant, I am in favor of him/her attending camp and accept the conditions named. The health history and application information are correct, as far as I know, and the person described herein has permission to engage in all prescribed camp activities, except as noted. In addition, I have read and understand this Emergency Treatment Authorization statement and give my full consent to the terms found herein.

Parent / Guardian Signature*

Date*

Contract of Release and Assumption of Risk Agreement: By signing below, I (parent or guardian) have been informed and made aware that during my child’s stay at the Camp Tyler Foundation, also known as, Camp Tyler Outdoor School, certain risks and dangers may occur. These include but are not limited to the hazards that arise from being in a wilderness area, team and individual sports, the forces of nature, as well as other such activities, including but not limited to, swimming, canoeing, caring for animals, as arranged by my organization. In consideration of Camp Tyler Foundation providing the facilities and my willingness to have our child, participant, engage in the above described and other various activities, I agree to indemnify, and do hereby release and hold Camp Tyler Foundation, also known as Camp Tyler Outdoor School, its officers, directors, trustees, agents, employees and/or volunteers harmless from any and all claims, liabilities, suits, actions, causes, damages or losses and demands of every kind and nature whatsoever, including without limitation, all costs and attorney’s fees, which I have or which may arise from physical or emotional injury, including fatality, together with any damage to Participant’s property or possessions, from or in connection with Participant’s stay or participation in activities at Camp Tyler Outdoor School which have been arranged or made available to Participant. I have the authority to grant this release on behalf of Participant. The terms hereby shall serve as a release and assumption of risk for Participant, the person executing this document on behalf of Participant, their heirs, executors, administrators and for all members of their family.

Parent / Guardian Signature*

Date*

Media Release Form

I grant permission to Camp Tyler and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Camp Tyler and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

Media Release Acknowledgement*

I acknowledge that I am over the age of 18.

I acknowledge that I am the legal guardian of the following:

If legal guardian of model(s), please list name(s) here:*

First Last

Signature*

Date*

Parent / Guardian Address*

Street Address Address Line 2 City State ZIP Code

Camper Profile

Camper Name*

First Last

Please help us to get to know and understand your camper better. The confidential information requested below is shared only with the appropriate camp staff involved with your child and is specifically intended to be used to help us better serve the needs of your child. This is to make sure we know the important information for your child to have a positive experience while at Camp Tyler.

Camper preferred name or nickname*

School*

Grade*

Age*

Swimming Ability*

Non-Swimmer

Fair Swimmer

Good Swimmer

Has your camper ever been to a camp before?*

Yes

No

If yes, how was the experience?*

What do you hope your camper will gain from their experience at Camp Tyler?*

Does your camper have any condition that may affect participating in camp activities?*

How would you describe your camper?*

Does your camper have any concerns about coming to camp that would be helpful for us to know?*

Please list some of your camper’s interest and hobbies.*

How does your camper get along with younger or older children?*

Code of Conduct

Admission to Camp Tyler carries privileges and responsibilities.

Welcome to Camp Tyler! Our goal is to provide a fun, safe, and inclusive environment where all campers can learn, play, and make new friends. To ensure everyone has a great experience, we ask all campers agree to actively participate using the Camp Tyler 4 C’s as stated below.

Please discuss with your camper, each of the following:

Responsibilities*

I will participate in all camp activities and programs.

I will communicate respectfully.

I will cooperate with campers and staff.

I will care for others and for the camp property.

I will commit to do my best in everything I do.

Consequences For Not Following The Code Of Conduct

If a camper does not follow the rules, the following steps may be taken:

Reminder & Redirection – A counselor will remind the camper of the rule and help them correct their behavior.
Time-Out or Reflection – The counselor may have the camper take a short break to reflect on their behavior.
Parent/Guardian Notification – If behavior continues, parents or guardians will be informed.
Camp Director Meeting – A discussion with the camp director and parents or guardians may be held to determine the best course of action.
Dismissal from Camp – In cases of serious or repeated behavior issues, parents or guardians may be contacted and the camper may be asked to leave camp. There will be no refunds of camp fees/tuition for this action.

In signing this, the camper agrees to abide by the Camp Tyler Code of Conduct.

Camper Signature*

Date*

Parent / Guardian Signature*

Date*

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Online Registration - 2025 Adventure Recreation Camp

Camper Health Form

Media Release Form

Camper Profile

Code of Conduct

Admission to Camp Tyler carries privileges and responsibilities.

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