Studio Campference!!

Studio Campference Registration

    Next Step Weekend for young adults that have been to a Next Step Campference and are between the ages of 21-29 held at Next Step office in Central Square. For more info please call Quita at 617-864-2921.
  • Date Format: MM slash DD slash YYYY
  • PARENT/GUARDIAN AND EMERGENCY CONTACT

  • Medical Overview

  • INSURANCE INFORMATION

    (Please bring your insurance card to the program)
  • Prescription
  • Over the Counter Medications: I—or my child, if under the age of 18—has permission to take over-the-counter medication, for the dosage amount suggested by the pharmaceutical maker, if feeling unwell due to symptoms such as headache or stomachache. Please check appropriate boxes and provide your signature below:
  • CONSENT AGREEMENT

  • AUTHORIZATION AND RELEASE This Consent Agreement, Authorization and Release must be read and signed to be eligible to attend Next Step's Young Adult Campference. RELEASE OF LIABILITY I understand that occasionally accidents occur during campference activities and that participants may sustain serious personal injury and property damages as a consequence thereof. Knowing the risks of campference activities, nevertheless, and in consideration of my acceptance for participation at a campference, I hereby agree to assume those risks and to hold harmless Next Step, and all campference agents, representatives, employees and volunteers, from any and all liability, claims for personal injury and/or property damage, costs, expenses and damages arising out of or connected in any way with my participation in campference activities. Further, I acknowledge that Next Step accepts no responsibility for the loss, damage or theft of my personal property.
  • CONSENT FOR MEDICAL TREATMENT

  • The undersigned hereby grants permission to the medical staff or consulting physicians at Next Step to administer medication and provide medical care for me, including any medical emergency care required. I also give my consent for any emergency transportation deemed necessary.
  • Community Agreement/Rules of Conduct

    Please select as an indication that you will adhere to the code of conduct.
    Please select as an indication that you understand the behaviors that are unacceptable at the program.
  • PHOTO AND INFORMATION RELEASE

  • I give Next Step permission to photograph and use pictures or visual and/or audiotapes of me in professional or fundraising activities. On occasion, with this permission, participant photographs may be included on the Next Step website, on a bulletin board, video, newsletter, campference album, or in personal photographs. Next Step respects the privacy of participants and does not allow unauthorized visitors to photograph the campference or participants. In addition, by signing below, I give Next Step permission to give my name, address and/or phone number to groups or individuals wishing to support Next Step by inviting me to an event or by sending me information related to Next Step. This list will not be sold or given to anyone else for any other reason.
  • Please Sign

    By signing below, I hereby acknowledge that I have read and fully understand the terms and expectations of the program. All information provided is current and accurate to the best of my knowledge.
  • Date Format: MM slash DD slash YYYY

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