Walking Into Wellness Education Camp Spring Contract

Camper's Full Name

First NameLast Name

Physical Address

Parent/Guardian 1 Name

First NameLast Name

Email

example@example.com

Address

Cell Phone

Parent/Guardian 2 Name

Email

example@example.com

Address

Cell Phone

Address

Alternate Emergency Contact

First NameLast Name

Cell Phone

Walking Into Wellness Education Camp Contract Terms: Pursuant to the receipt and acceptance of the application, this "Camp Contract" is entered into by and between Nicole Rothschild of Walking Into Wellness Education Camp, (hereinafter: "WWEC"), and the parent(s) or guardian(s) whose signatures appear below. The parties hereto accept the following terms and conditions governing the camper's enrollment at WWEC. I/we understand that this is a temporary enrollment contract. My camper's enrollment at Walking Into Wellness Education Camp shall be only during the session chosen. I further understand that if I have multiple campers, each camper must have their own contract filled out in full. Tuition rates for each 10-week program includes all material costs per day. Full camp payment is due with the contract upon registration. Cash/ Checks/ Paypal/ Venmo only. Please make all checks payable to Nicole Rothschild If you need to cancel, we require 48 hours notice, prior to the start of the program. $300 of the registration fee will be applied to a non-refundable deposit. In the event of a cancellation with proper notice, the refundable portion will be the remainder of tuition, less the deposit. There will be no refunds for days missed, due to the need for purchasing supplies for registered participants. If any changes or cancellations are made less than 48 hours to the start of the program, the family will forfeit fees already collected. Camp will ensue rain or shine. In the event of unsafe weather conditions (for example: air quality) families will be notified of back up indoor location. In the event, a location cannot be secured, the families will be reimbursed for that week minus a 20% administration fee.

Fern (1 week of camp) Redwood (Entire 10 week session)Redwood *Entire 10 week session)

Please select weeks below

If medical care is deemed necessary and I cannot be contacted, I authorize Nicole Rothschild of Walking Into Wellness Education Camp ("WWEC") to act on my behalf in deciding the proper course of action for my camper. This includes but is not limited to permission for WWEC to render any emergency medical treatment that WWEC staff deem appropriate and/or necessary for the wellbeing of my camper, including, but not limited to First Aid, CPR, calling emergency ambulance transportation and hospitalization, if necessary. I understand and agree that any and all actions taken by WWEC for the benefit of my camper comes at my cost, including but not limited to, emergency medical treatment or care and ambulance transportation. I promise to hold Nicole Rothschild and WWEC harmless and indemnify WWEC for any and all costs associated with any medical treatment it has deemed necessary and/ or appropriate for the well-being of my camper, including, but not limited to, any and all costs associated with emergency room visits, hospital care, and ambulance services. I specifically release WWEC from any and all claims, loss, costs, damage, or expenses arising out of or from the exercise of their discretion in seeking medical treatment on behalf of my camper as WWEC may deems necessary and/or appropriate, and also release WWEC from any and all claims, losses, costs, damages, and/or expenses associated with any negligent treatment or medical malpractice committed by any medical professional, which I might otherwise pursue against WWEC in whole or part, including joint or several liability.

MEDICAL CONCERNS (Please list all medical concerns, use a separate page if necessary)

ALLERGIES (Please list all allergies)

Does your child have any special needs that should be recognized?

If yes, what special accommodations or modifications are needed? (Please use a separate page if necessary)

Iunderstand that this program is entirely outside rain or shine. In the event of unsafe weather conditions a back up location will be secured. SIGN IN: Child must be signed in by Nicole Rothschild at the trailhead/entrance parking lot. Camper must be dropped of at 9am. The group will wait 15 minutes maximum before departing from starting location. If after 15 minutes the child is not present, and parents have not contacted Nicole, families will forfeit attendance for the day. SIGN OUT: I understand that my camper must be picked up by the time his/her contracted program ends. Pick up is at 3pm. If my camper is not picked up on time, program staff will attempt to contact me first and then attempt to contact all emergency contacts. I understand that there is a charge if I do not pick my camper up by the above stated times. This charge is $30 and will be due by cash or credit card prior to the camper returning to the program. If a child is not picked up within a half an hour of contracted end time and there has been no contact from parent(s) nor emergency contacts, emergency services will be called. I understand that multiple late pick-ups may result in my camper being dismissed from the program. ABSENCES: I will contact Nicole Rothschild by phoning the mainline of WWEC. (805-431-9744) to notify when my camper will be absent from the program. I understand that if absent from camp, there will be no adjustment of fees. TARDINESS/EARLY PICK UP: Please call Nicole Rothschild when a camper will be tardy, or picked up early. Please give advanced notice in order to best accommodate. The group may move to a different area throughout the day. I understand that if tardy to camp, there will be no adjustment of fees.

Campers enrolled in Walking Into Wellness Education Camp are expected to follow all site specific and licensing specific rules, along with the Walking Into Wellness Education Camp code of conduct:

1.Demonstrate a respect for Walking Into Wellness Education Camp staff by listening and following directions.

Demonstrate a respect for WWEC property by treating supplies and materials with care.

3. Demonstrate a respect for nature by keeping the areas we visit clean and unharmed and if possible better than when we found it.

4. Demonstrate a respect for others, including respecting peer's bodies, thoughts, feelings and beliefs.

As part of the WWEC, we want to ensure that our campers demonstrate positive and safe behavior while they are attending our program. In general, we have a "Three- Strike" policy. Please be aware that under certain circumstances, WWEC may dismiss a camper after one strike. In the event of dismissal, families will not be reimbursed payment. CODE OF CONDUCT: I have read and reviewed the WWEC Code of Conduct with my camper. I am aware that any violation of the Code of Conduct may result in my camper being dismissed from the

Child Protection Iunderstand that all staff members WWEC are required by law to report any evidence or knowledge of suspected child abuse or neglect to the County Department of Social Services.

Entire Agreement and Binding Effect. This Agreement, along with the other documents referred to herein, is the final integration of the agreement between the parties with respect to the matters covered by it and supersedes any prior understandings or agreements, oral or written, with respect thereto. The provisions of this Agreement shall inure to the benefit of, and be binding on, the parties and their successors, assigns, employees, legal representatives, heirs, distributes, and transferees. Governing Law, Jurisdiction and Venue. This Agreement shall be governed by and construed in accordance with the laws of the State of California applicable to contracts to be performed solely within such state. Modification, Waiver and Severability. This Agreement may not be modified or supplemented except by written instrument signed by the parties. No waiver of any default or breach of any agreement or provision herein contained shall be deemed a waiver of any other default or breach thereof or of any other agreement or provision herein contained. If any provision or portion of a provision of this Agreement is declared void and/or unenforceable, such provision or portion shall be deemed severed from this Agreement, which shall otherwise remain in full force and effect. Attorneys' Fees and Costs. In the event any suit or other action is commenced to construe or enforce any provision of this Agreement, the prevailing party shall be awarded reasonable attorneys' fees and court costs, in addition to all other relief to which such party shall be entitled. Counterparts/Electronic Signatures. This Agreement may be executed in one or more counterparts, all of which taken together shall constitute one instrument. A facsimile or other electronic copy of a signature on this Agreement shall be acceptable as and deemed to be an original signature. My signature below confirms that I have read and understand the terms and conditions of this Summer Camp Contract, and I agree to all the terms and conditions contained herein.

Parent Guardian Name

First NameLast Name

Parent/Guardian 1 Signature

Date

Walking Into Wellness Education Camp

MEDICAL RELEASE FORM AND EMERGENCY PROCEDURES EMERGENCY MEDICAL RELEASE:

ATTENDANCE PROCEDURES