RELEASE OF LIABILITY
AND
INSURANCE INFORMATION
2013 Summer camp season
Return this Release at time of registration no later than May 1, 2013.
This form maybe submitted directly online from the web site, or mailed to Winter Address: Echo Hill Ranch, 8601 Georgia Ave, Suite 810, Silver Spring, MD. 20910 or faxed to: 301-588-4041
 
I hereby grant permission for my son/daughter, to attend and participate in all camp activities at Echo Hill Ranch this summer. I understand that Echo Hill Ranch will provide supervision for all activities and make sure that every reasonable effort will be made to ensure the safety of all participants. I release the owners of Echo Hill Ranch, Inc., and their employees , and the owners of the land known as Echo Hill Ranch, from any liability for any injury or illness to my son/daughter.
In case of an illness or injury, if I cannot be reached after reasonable efforts, I give Echo Hill Ranch, Inc. the authority to act in my behalf for the care and treatment of my son/daughter.
In the event of illness or injury I hereby give permission for Echo Hill Ranch, Inc. staff to take my child to Sid Peterson Memorial Hospital in Kerrville, Texas or the nearest physician and/or hospital for appropriate treatment. In the event that I cannot be reached after reasonable efforts, I give permission to Sid Peterson Memorial Hospital and the physicians at the Hospital or others selected by Echo Hill Ranch staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery if necessary.
I agree to be responsible for all medical expenses related to the treatment of my child.
 
All information below must be completed so we can quickly access health care or prescriptions for your child if necessary:
Health Insurance Provider:
Health Insurance Provider Telephone:
Health Insurance Provider Address:
Insurance Policy #: Group #:
Insurance Policy Holder:
Insurance Policy Holder’s Birth date & SSN:
Parent/Guardian
Signature: Date:
Echo Hill Ranch
Summer Telephone: 830-589-7739 Summer Fax: 830-589-2520
Email: EHranch@aol.com www.echohill.org