In consideration for being allowed to register and participate in Camp Wheez, sponsored by Sansum Clinic, held August 4 through August 8, 2025, as parent/guardian I release Sansum Clinic and its partner organization Sutter Health, along with their affiliates, subsidiaries, incorporators, physicians, board members, trustees, officers, directors, employees, agents, independent contractors and volunteers, from any liability for damages, injuries, or losses which may result from participation in Camp Wheez, including any necessary transportation. I have reviewed the scheduled activities, and my child has permission to engage in all such activities except as noted in writing by a physician or parent/guardian. I give permission to the camp physician to initiate and provide any necessary treatments, including transporting to the nearest certified emergency facility. If hospitalization or other treatment is required, my child is to be referred to an appropriate physician and all care and treatment will be at my expense.

I consent and authorize Camp Wheez to use and reproduce photographs or videos of my child taken while participating at Camp Wheez, and written comments made by or about my child in connection with Camp Wheez, for promotional and informational materials.

At the conclusion of camp, camp staff may release my child to the individual(s) designated below. I understand that under no circumstances will my child be released to anyone not specified below.

Enter your full name below to agree and sign.