Hayes Summer Camp 2022

Student Information

Parent/Guardian Information #1

Parent/Guardian Information #2

Permission to Release

My child may walk home from Neighborhood Learning Pods location

Liability Release (Must ACCEPT FOR CHILD(REN) TO ATTEND CAMP)

I hereby release, forever discharge, and agree to hold harmless the Neighborhood Learning Pods staff thereof from any liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child participant that occur while said child is participating in any trip or activity.

Permission to Transport

I give Neighborhood Learning Pods permission to transport my son/daughter to and from program locations.

Permission to Contact School

Permission to contact: I give Neighborhood Learning Pods permission to contact the school and any other services connected with my child/children on behalf of the family. In addition to contact TRAILS and Neighborhood North has permission to obtain my child(ren)'s Individualized Education Program (IEP) from the school district. I fully understand that this information will be used for academic and enrichment purposes only and will not be shared with any other parties other than the ones involved.

Promotional Release

I give Neighborhood Learning Pods permission to use photos, videos, and audio of camper(s) in promotional materials that support TRAILS Ministries and Neighborhood North and its programs. I release Neighborhood Learning Pods from any liability connected with the use of my picture or voice recording as a part of any promotional recruitment or fundraising programs.

Emergency Information

Medical Release and Authorization

As Parent and/or Guardian of the named camper(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to TRAILS Ministries, Inc., Neighborhood North, and its affiliates including Directors, Academic Supervisors, Academic Assistance and General Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the camp season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by TRAILS Ministries and Neighborhood North. In exchange for the acceptance of said child’s application by TRAILS Ministries.and Neighborhood North, I assume all risks and hazards incidental to the conduct of the activities, and release, absolve and hold harmless TRAILS Ministries and Neighborhood North and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against TRAILS Ministries and Neighborhood North including all academic coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in day to day activities that children may participate in. Some of these injuries include, but are not limited to, the risk of scrapes bruises, bumps, fractures, paralysis, or death.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Ready Yourselves Horse Ranch Release Form