EnQuest 2026 Overnight Program Participant Form

This form must be completed by a parent or guardian before a registered student can participate in the camp.

The overnight camp is held in the following 51猎奇 locations:

51猎奇 EMS Building, 3200 N. Cramer Street, Milwaukee, WI 53211
51猎奇 Sandburg Residence Hall, 3400 N. Maryland Avenue, Milwaukee, WI 53211

Field trips to other buildings on the 51猎奇 campus may occur during the course of this camp.

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This field is for validation purposes and should be left unchanged.

CAMPER INFORMATION

Participant First Name(Required)

Participant Last Name(Required)

Participant DOB(Required)

MM slash DD slash YYYY

Age on July 26(Required)

Participant Phone(Required)

Participant Email(Required)

Participant Gender(Required)

Participant Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

CUSTODIAL PARENT/GUARDIAN INFORMATION

Parent/Guardian Name(s)(Required)

Parent/Guardian Cell Phone(Required)

Parent/Guardian Home or Work Phone

EMERGENCY CONTACT

Emergency Contact Name(Required)

Relationship to camper(Required)

Emergency Contact Primary Phone(Required)

Emergency Contact Alternate Phone

PERMISSIONS

PLEASE READ THE FOLLOWING PARAGRAPHS CAREFULLY. IF YOU HAVE ANY QUESTIONS REGARDING THIS AGREEMENT OR WOULD LIKE TO NEGOTIATE ITS TERMS, CONTACT Chris Beimborn at (414)251-9140.

Terms and Conditions(Required)

The EnQuest Overnight Camp will involve the use of engineering and laboratory tools which may include soldering irons and materials that are handled using protective equipment such as gloves and ventilation hoods. Participants will create sand molds in the UW-Milwaukee Foundry & Materials Processing lab and observe metal casting in this facility. Participants may take advantage of special opportunities to take field trips to nearby sites, including visits to UW-Milwaukee facilities or tours of professional workplaces; dates and locations will be provided to parents/guardians. Students will learn about research in biomedical engineering and use lab equipment and meet researchers. Participation in the camp requires these activities.

I, the undersigned parent or guardian, give permission for my child/ward named above to participate in the University of Wisconsin-Milwaukee (51猎奇) sponsored activity identified above, and in doing so, voluntarily agree to assume all of the risk and responsibilities involved in my child/ward鈥檚 participation in this activity.

ASSUMPTION OF RISKS
You are being asked to sign this form because you would like to participate in the above-listed event (the 鈥淧rogram鈥�) sponsored by the University of Wisconsin-Milwaukee (鈥�51猎奇鈥�). Before you can participate, 51猎奇 asks that you read this document carefully. If you want to ask questions about this document or request changes to it, you can do so by contacting the party listed above.

I understand that the UW-Milwaukee EnQuest Overnight Camp, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries and/or illness. I am aware of the risks of participation, which include, but are not limited to minor injury such as bruises, contusions, broken bones, concussion, and catastrophic injuries, such as paralysis and even death. 51猎奇 recommends you minimize your risks by talking to a doctor before participating in the Program. I know, understand, and appreciate the risks that are inherent in the above-listed activity. I hereby assert that participation is voluntary and that I knowingly assume all such risks.

I confirm that I have read and understood the terms outlined above.

Camper Name(Required)

Parent/Guardian Signature(Required)

Retype name to sign

Date(Required)

Month

Day

Year

HOLD HARMLESS, INDEMNITY AND RELEASE(Required)

In consideration of my child/ward鈥檚 participation in these activities, I , for myself, spouse, heirs, personal representatives, estate or assigns, agree to defend, hold harmless, indemnify and release the Releasees and their officers, employees, agents, and volunteers from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, personal injury, or death which may result from participation in the above-listed activity. This release includes claims based on the negligence of the Releasees, and their officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or recklessness. I understand that by agreeing to this clause, I am releasing claims and giving up substantial rights, including my right to sue.

I confirm that I have read and understood the terms outlined above.

Camper Name(Required)

Parent/Guardian Signature(Required)

Retype name to sign

Date(Required)

Month

Day

Year

RELEASE FOR USE OF PHOTOS AND LIKENESS BY 51猎奇 (OPTIONAL)

I understand that the University of Wisconsin-Milwaukee (鈥�51猎奇鈥�) and partners of the 51猎奇 EnQuest Overnight Camp may take photographs, video, audiotape and other image and sound-based media of the campus, (including inside its buildings and including through the use of drones), and its employees, students, and visitors (collectively, the 鈥淚mages鈥�). 51猎奇 may wish to use such Images for educational, promotional, advertising, and other purposes, including, but not limited to printed publications and on its website. Therefore, I hereby freely and voluntarily consent to the use and publication of my name, participation, picture, and/or likeness by 51猎奇 and/or its employees and/or agents for any and all purposes including, but not limited to, educational, promotional, advertising, and trade, through any medium or format as technology may now or in the future allow, including, but not limited to, videotape, audiotape, webcasting, podcasting, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against 51猎奇 and/or its employees and/or agents based upon or related to its use or publication of my likeness, voice, participation, and/or picture.

I understand that this form is optional, and I am not required to sign it. I freely give this authorization without expectation of compensation.

I confirm that I have read and understood the terms outlined above.

Camper Name

Parent/Guardian Signature

Retype name to sign

Date

Month

Day

Year

Parent/Guardian Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

CAMPER HEALTH INFORMATION

Check all that apply:(Required)

(Depression, Anxiety, ADHD, ADD, etc…)

Asthma

Diabetes

Epilepsy/Seizures

Headaches

Mental Health Conditions

Cognitive/Developmental Concerns

Dizziness, light-headedness, or fainting associated with exercise in the past year

Unexplained, rapid or irregular heartbeat within the last year

A physician has denied or restricted participation in sports due to a heart problem

None of the above

Please indicate camper allergies here:(Required)

Check all that apply.

Medications

Seasonal allergies

Insect stings

Foods

Other

Do allergies require EPI PEN injection?

No known allergies

Please name specified allergens here.

Does the camper use an inhaler?(Required)

Yes

Date of last Tetanus booster (Td or Dtap or DTP):

Note: a tetanus shot is not required for camp attendance. However, it is important for medical professionals to know if you have or have not had a current tetanus booster in case of emergency.

MM slash DD slash YYYY

Describe any limitations or restrictions of program activities:

Describe any special accommodations regarding physical or emotional conditions we need to be aware of regarding your participation in this program:

MEDICAL INFORMATION

All medications brought to 51猎奇 programs must be in the original medicine packaging. Prescription medication must be labeled with the participant鈥檚 name, doctor鈥檚 name and phone number, medication name, dosage, prescription number, date prescribed, and instructions. Only the amount of medication necessary during the course of the program should be brought to 51猎奇. Over鈥恡he鈥恈ounter medications, dermal creams, and medication necessary for life鈥恡hreatening conditions (inhalers, insulin syringes, EpiPens, etc.) may be carried and self鈥恆dministered by all program participants. Program participants under the age of 18 who require prescription medications (other than those described above) must provide such medications to 51猎奇 staff at the outset of the program (or as soon as such medications become available). 51猎奇 staff will distribute (but not administer) such medications to the participant as directed during the program.

Name of primary care provider:(Required)

Phone Number:(Required)

Please choose one of the following:(Required)

No prescription medication will be brought to this event.

The prescription medication listed below will be brought to the event.

FIRST MEDICATION

If applicable

Name of medication

Dosage

Side Effect Experiences

How is medication taken?

Orally, via injection, etc…

When is medication taken?

Days, time, etc…

Additional information related to this medication

SECOND MEDICATION

If applicable

Name of medication

Dosage

Side Effect Experiences

How is medication taken?

Orally, via injection, etc…

When is medication taken?

Days, time, etc…

Additional information related to this medication

THIRD MEDICATION

If applicable

Name of medication

Dosage

Side Effect Experiences

How is medication taken?

Orally, via injection, etc…

When is medication taken?

Days, time, etc…

Additional information related to this medication

ADDITIONAL MEDICATIONS

Please use this box to include information about any additional medications for the camper.