Please read the following:
In keeping with the college's mission of providing eduction to young people demonstrating financial need, Camp Lookout is for
Stone and Taney County children (ages 8-12) who otherwise would not be able to experience a summer camp program. Limited
finanicial information will be obtained to determine eligibility. Immunization records are needed for first-time campers.
* - Indicates required field.
Emergency Contacts (other than parents)
(We cannot consider your child without this information)
We do not accept week requests; however, please list those dates that your child will be unavailable
to attend camp and why. Please keep in mind children cannot leave camp and return (i.e. for baseball games, family
reunions). We do not accept cabin mate requests; however, if your child must travel
with another camper, please list their names.
Attention: Camp Lookout does not offer insurance coverage for campers while in residence at camp.
Please fill out this information box regarding your family insurance policy.
My son/daughter has permission to participate in the activities at Camp Lookout. In consideration of
my child's attence at Camp, I understand I am accepting full responsibility for my son/daughter. If an accident
should occur injruing my son/daughter, including, but not limited to, death, or serious injury, I, on behalf
of myself, my heirs or successors, hereby release Camp Lokout, College of the Ozarks, and their trustees,
directors, officers, agents, employees, counselors, or students from liability. I have filled out the information
box regarding my family insurance policy. I understand that any expenses incurred for medical treatment of my
son/daughter will be my responsibility. I agree on behalf of myself and my heirs and successors to indemnify and hold
harmless Camp Lookout and College of the Ozarks from any loss, cost, judgement or other harm, including attorney fees,
which might come to them arising from my child's attendance at Camp Lookout.
I grant permission for Camp Lookout or College of the Ozarks to photograph, record, or video my child during
camp and to use those materials for promotional or other purposes.
The following information must be completed by the parent/guardian. The intent of this information is to provide
camp health care personnel the background of the camper, in order to provide appropriate care. Please leave both textboxes
blank if the allergy or health issue does not apply to your child.
Is there any particular information about your child (medical, emotional, dietary treatment, ongoing medication, allergies, special
cirumstances, etc.) that you want to be certain the Camp Director and/or counselor are aware of? If so, please give a
Please list ALL medication(s) (including over-the-counter or non prescription drugs) taken routinely. Bring enough mediation
to last the entire time at camp. Keep it in the original packaging/bottle that identifies the prescription physician (if a
prescription drug), the name of the medication, the dosage, and the frequency of administration.
Identify any medication taken during the school year that the camper WILL NOT take during the summer:
The following restrictions apply to this camper:
Parent/Guardian Authoization: This health history is correct and complete as far as I know, and the person
herein described has permission to engage in all camp activities axcept as noted above.
PERMISSION TO PROVIDE MEDICAL TREATMENT OR EMERGENCY CARE
I hereby give permission to Camp Lookout to make any and all arrangements deemed appropriate and in the
best interests of my son/daughter for medical, surgical, and dental care. In the event I cannot be reached in
an emergency, I hereby give permission to a healthcare provider to secure and administer treatment,
including hospitalization, for my son/daughter. I understand that parental permission is required for operative
procedures on minors. By checking the box, I am giving my permission that operative procedures may be promptly
carried out. I understand that all costs related to such care are my responsibility. I understand that Camp
Lookout is not responsible for my son's/daughter's pre-existing injuries or illnesses or any aggravation of
these conditions. I understand that Camp Lookout will not assume responsibilities for illness or injury incurred
while my son/daughter is participating in camp activities.
*I authorize release of any medical information to process insurance claims and request payment of benefits of the
physicians or supplier for services.