Camp Wack

I certify that by submitting this form, I am the parent or legal guardian of the person whose information is being provided to Modified Athletics For Kids, Inc. ("Modified Athletics") (or, if I am the individual signing myself up for Camp WACK, I am at least 18 years old and do not require a guardian).

I acknowledge that Modified Athletics intends for the information I am submitting to be available only to Modified Athletics staff and to be password protected; however, the information will be stored via the internet, and there are limitations to security and privacy of the internet that are beyond our control. Modified Athletics cannot guarantee that all data submissions will be secure or that your information will remain private.

I acknowledge that if my child is no longer a participant in Camp WACK (or if applicable, I am no longer a participant), I can request that Modified Athletics delete from its databases all personally-identifiable information that I’ve submitted, except that information which Modified Athletics is legally obligated to retain.

Dear Camper and Family,

We are very excited for this summer's Water Adventure Camp for Kids (Camp WACK). In order to assist you in your preparation for camp, here is some helpful information. Camp WACK will be held on July 8, 9, and 10 in Lafayette with each camper selecting a two-hour window to attend. We will allow 8 participants for each two-hour window to allow for maximum ski time. All campers must have at least one parent/caregiver present with them at camp, at all times.

Please keep the Directors updated if your plans change or you are unable to attend by contacting Nikki Shaffer at (317) 258-4457, Christyn Hooker at (574) 952-2206, or emailing us at: campwack@gmail.com

To pay your Camp WACK registration fee please utilize our PayPal account - link will be provided at the completion of this form. If cash or check is preferred, please make your payment to Modified Athletics for Kids and mail to:**

Christyn Hooker
60524 CR 1
Elkhart, IN 46517

**Your registration is not complete/guaranteed until payment is received

Please bring the following items with you:

• Bathing suit or comfortable, cool clothing that can get wet
• Change of clothes for after skiing
• Towel
• Sunscreen
• Hat or sunglasses
• Bug spray
• Water Bottle
• Camera/Video
• Lawn chairs

If you have any questions and/or concerns please contact the Camp WACK Directors:

Nikki Shaffer at (317) 258-4457, Christyn Hooker at (574) 952-2206, or email us at: campwack@gmail.com

The Lafayette Camp is currently full. To be put on the waitlist, please add your preferred day and times in the field below. If an opening becomes available, we will reach out to you.

Days and Times of Camp are:

• July 8 from 8:30 - 10:30
• July 8 from 11:30 - 1:30
• July 8 from 2:00 - 4:00
• July 9 from 8:30 - 10:30
• July 9 from 11:30 - 1:30
• July 9 from 2:00 - 4:00
• July 10 from 8:30 - 10:30
• July 10 from 11:30 - 1:30
• July 10 from 2:00 - 4:00

The Camp WACK staff wants to ensure an enjoyable experience for each camper. In order to achieve this we are requiring that each child be accompanied by an adult AT ALL TIMES, unless in the water under the supervision of camp staff. The ONLY exceptions to this rule are campers with physical impairments only and at least 16 years old. Medical services will be on site and parents/participants are responsible for seeking treatment as necessary.

Due to safety considerations, parents / siblings WILL NOT be permitted in the water or on watercraft at any time during camp. Specific requirements and training are mandatory for any individuals working in these areas. We also ask for parents/siblings to stay OFF of the dock. The dock has limited capacity and often gets crowded with skis, wheelchairs and camp staff. We need to have room to maneuver equipment on the dock as well as take care of skiers getting in/out of the water.

Guardian Participation:

I HAVE READ THE ABOVE AGREEMENT, I UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS CONTAINED HEREIN. I AM SIGNING THIS AGREEMENT VOLUNTARILY

This form may be used for any of the following photography or recording needs:

• Photographing, recording, and/or illustrating of individual for the use of Modified Athletics for Kids and Camp WACK to print or publish in its own publications and marketing.
• Photographing, recording, and/or illustration of individual for release to the news media.

I certify that by submitting this form, I am the parent or legal guardian of the person whose information is being provided to Modified Athletics For Kids, Inc. ("Modified Athletics") (or, if I am the individual signing myself up for Camp WACK, I am at least 18 years old and do not require a guardian).

I acknowledge that Modified Athletics intends for the information I am submitting to be available only to Modified Athletics staff and to be password protected; however, the information will be stored via the internet, and there are limitations to security and privacy of the internet that are beyond our control. Modified Athletics cannot guarantee that all data submissions will be secure or that your information will remain private.

I acknowledge that if my child is no longer a participant in Camp WACK (or if applicable, I am no longer a participant), I can request that Modified Athletics delete from its databases all personally-identifiable information that I’ve submitted, except that information which Modified Athletics is legally obligated to retain.

In exchange for my being allowed to participate in the Modified Athletics for Kids-Camp WACK (“program”), I, and if I am not yet 18 years old, my parent or legal guardian, agree to be bound by each of the following:

1. Identification of Risks. I understand that participation may involve risk of injury, disability or death.
2. Assumption of Risks. I assume all risks connected with my participation in the Program. I accept personal responsibility for any liability, injury, loss or damage in any way connected with my participation in the Program.
3. Assumption of Risks. I assume all risks connected with my participation in the Program. I accept personal responsibility for any liability, injury, loss or damage in any way connected with my participation in the Program.
4. Indemnification. I agree to indemnify, defend, and hold harmless, Modified Athletics for Kids and Camp Wack, and all of its affiliated organizations, directors, officers, employees, agents, successors, and assigns from any claims, responsibilities, or liabilities, including attorney’s fees, out of my participation in the Program.

5. Consent for Medical Treatment. I agree that Modified Athletics for Kids and Camp WACK may, but have no duty to provide me, through medical personnel of their choice, medical assistance, transportation, and emergency medical services. *OR*

   IF THE PERSON PARTICIPATING IN THE PROGRAM IS NOT YET 18 YEARS: As a parent or legal guardian of the above named child, I verify that I fully agree to, understand, and accept all provisions of this Waiver, Release, and Consent.

Waiver/release of liability/consent to medical attention:

THIS IS A LEGAL DOCUMENT AND IS A BINDING CONTRACT AND RELEASE. IF YOU DO NOT UNDERSTAND ANY PORTION OF IT OR DO NOT WISH TO AGREE TO THE TERMS CONTAINED HEREIN, CONSULT AN ATTORNEY AND DO NOT SIGN THIS DOCUMENT. I HAVE READ THIS WAIVER, RELEASE, AND CONSENT AND UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS CONTAINED HEREIN. I AM SIGNING THIS WAIVER, RELEASE, AND CONSENT VOLUNTARILY.