Winter Skate Camp 2022/2023

2022/2023 Winter Skate Camp
Join Island Camps for Our One-Day Mobile Skate Camps

Please take your time to make sure all your information is correct before submitting. If you have any questions or need help completing your regsitration you can call us at 954-281-2797

Dates: Week 1, December 26th - 30th Week 2, January 2th - 6th

Drop Off: 8:30am - 9:00am

Pick Up: 3:00pm - 3:30pm

Location: Skate Camp is a mobile camp. We depart from Island Water Sports, 1985 NE 2nd Street, Deerfield Beach, FL 33441 at 9am and return at 3pm. We visit two skateparks each day.

Ages: 8-15 (Call for exceptions 954-281-2797)

Cost:
Day Camps $99/Day

Skills Required: None. All levels and abilities welcome. Skateboards and helmets provided for those who do not have their own.

Cash/Check Payments: We are no longer taking paper applications. If you want to pay by cash or check, please complete this form and use coupon code 'CASH'. Checks can me made payable to Island Surf & Sport and brought to Island Water Sports to confirm your registration.

CoVID-19 Updated Policies:

The health of our campers and families is of the upmost importance to us. We are continually updating our policies according to CDC and our local government reccommendations. You can read our current policies here

Choose Your Days (Limited to 12 Spots Each Day):

One Day of Skate Camp

Choose Your Day	Number of Campers	Price
SOLD OUT Friday 1/6		$99.00

Item subtotal:$0.00

Enter coupon

Total $0.00

Camper Information
Camper #1*

First Name Last Name
Birth Date*

Month Day Year
Grade*
Name and City of Current School*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.*
How did you hear about our camp?*

Camper 2 (Click to add an additional camper)
Camper #2

First Name Last Name
Birth Date

Month Day Year
Grade
Name and City of Current School
Gender

MaleFemale
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

Camper 3 (Click to add an additional camper)
Camper #3

First Name Last Name
Birth Date

Month Day Year
Name and City of Current School
Grade
Gender

MaleFemale
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

Camper 4 (Click to add an additional camper)
Camper #4

First Name Last Name
Birth Date

Month Day Year
Name and City of Current School
Grade
Gender

MaleFemale
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

Parent/Guardian Information
Parent/Guardian Information
Parent Name*

First Name Last Name
Parent Home Number*

Area Code Phone Number
Parent Cell Number*

Area Code Phone Number
Parent E-mail*
Emergency Information
Emergency Contact 1 Name*

First Name Last Name
Emergency Contact 1 Relationship*
Emergency Contact 1 Phone Number*

Area Code Phone Number
Emergency Contact 1 Alt. Phone Number

Area Code Phone Number
Emergency Contact 2 Name

First Name Last Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone Number

Area Code Phone Number
Emergency Contact 2 Alt. Phone Number

Area Code Phone Number
Camper Drop-Off and Pickup
List the names of persons authorized for dropping off and picking up your child at camp:
Drop-off/Pickup Name 1

First Name Last Name
Drop-off/Pickup Phone Number 1

Area Code Phone Number
Drop-off/Pickup Name 2

First Name Last Name
Drop-off/Pickup Phone Number 2

Area Code Phone Number
Drop-off/Pickup Name 3

First Name Last Name
Drop-off/Pickup Phone Number 3

Area Code Phone Number
Drop-off/Pickup Name 4

First Name Last Name
Drop-off/Pickup Phone Number 4

Area Code Phone Number
I authorize my child to walk home from camp:*

YesNo
Other instructions, comments, or suggestions concerning camper(s):
Notice to the Minor Child's Guardian

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF THE RELEASED PARTIES AS DEFINED HEREIN USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM RELEASED PARTIES IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND RELEASED PARTIES HAVE THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
1. Definitions. The “Equipment” means the equipment listed above and any of its components. The person who is renting and/or using the above listed Equipment, or participating in any activity sponsored or offered by Released Parties shall be referred to as “Participant.” The “Undersigned” means only the Participant when the Participant is age 18 or older OR it means both the Participant and the Participant’s parent or legal guardian when the Participant is under the age of 18. “Released Parties” mean Island Surf and Sport, Inc., God’s Grace & Mercy, Inc., and Island Water Sports of Deerfield Beach, Inc., and their respective successors in interest, affiliated organizations and companies, subsidiaries, insurance carriers, agents, employees, representatives, assignees, officers, directors, members, and shareholders. The “Activity” means renting and/or using the above listed Equipment, or participating in any activity sponsored or offered by Released Parties.
2. Risks of Activity. Participant will be taking part in activities that can be hazardous and involve the risk of physical injury and/or death. The activities are inherently dangerous and Undersigned fully realizes the dangers of participating in the activities. The dangers and risks of the activities include, but are not limited to the condition of the premises and equipment, and the acts, omissions, representations, carelessness, and negligence of the Released Parties. Recognizing the risks and dangers, the Undersigned voluntarily chooses for Participant to participate in the activities and expressly assumes all risks and dangers of the participation in the activity, whether or not described above, known or unknown, inherent, or otherwise.
3. Equipment Use and Damage. The Equipment is rented “as is” and with no warranties, express or implied. The Undersigned accepts full responsibility for the care of the equipment during the rental period. Undersigned agrees to pay for any damage that occurs to the Equipment and/or the replacement at full retail value of the Equipment regardless of the circumstances under which such damage may occur. Undersigned agrees to pay for the replacement at full retail value of the Equipment for Equipment not returned to Released Parties. Undersigned also agrees to pay for any lost rental income for the period of time the Equipment is out of service due to damage for which Undersigned is responsible. Undersigned agrees to pay for any costs incurred in retrieval of Equipment if abandoned. Undersigned agrees to pay all costs, including reasonable attorney’s fees, incurred by Released Parties to collect any sums due or to enforce any terms of this agreement. Undersigned agrees to pay interest of 18% per annum on all sums owed to Released Parties. The Undersigned agrees that Released Parties are authorized and shall have the right to charge the Undersigned’s credit card for any sums owed. Improper use of the Equipment, as determined solely by Released Parties, shall result in the immediate confiscation of the Equipment. There shall be no refund of any monies paid in the event of such confiscation and any deposit shall be forfeited. All monies paid for the rental of the Equipment are non-refundable. Undersigned acknowledges that Participant has read and understands the rules for the use of the Equipment
4. Release and Indemnification: In consideration of the Participant being permitted to rent or use the Equipment, or participate in the Activity, the Undersigned (a) unconditionally release, forever discharge, and agree not to sue the Released Parties from and for any claims or causes of action for any liability or loss of any nature, including personal injury, death, and property damage, arising out of or relating to Participant’s participation in the Activity, including, but not limited to claims of negligence, breach of warranty, and/or breach of contract the Undersigned may or will have against the Released Parties; and (b) agree to indemnify, defend, and hold harmless the Released Parties from and against any liability or damage of any kind and from any suits, claims or demands, including legal fees and expenses whether or not in litigation, arising out of, or related to, Participant’s rental or use of the equipment, or participation in the Activity. IN THE CASE OF A MINOR PARTICIPANT, THE ABOVE WAIVER, RELEASE, AND AGREEMENT NOT TO SUE ONLY APPLY TO DAMAGES RESULTING FROM INHERENT RISKS OF THE ACTIVITY IN ACCORDANCE WITH FLA STAT 744.301.
5. Minor Acknowledgment. By signing this Agreement without a parent or legal guardian’s signature, Participant, under penalty of fraud, represents that he/she is at least 18 years of age. If signing as the parent or guardian of a minor Participant, signing adults represent that they are a parent or legal guardian of the minor Participant.
6. Miscellaneous. The Undersigned agree: (a) Participant will not engage in any activities prohibited by any applicable laws, statutes, regulations and ordinances; (b) this Agreement shall be governed by the laws of the State of Florida, and the exclusive jurisdiction and venue for any claim shall be located in the state courts located in Broward County, Florida; (c) Undersigned authorizes and gives full consent to Released Parties to copyright and/or publish for public view any and all photographs, digital recordings, videotapes and/or film in which Participant appears. Undersigned agrees that Released Parties may transfer, use, or cause to be used, these digital recordings, photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, television programs, and internet without limitations or reservations; and (d) this agreement shall be binding upon the subrogors, distributors, heirs, next of kin, executors, and personal representatives of the Undersigned.
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations and guidelines which Island Camps strives to comply.

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:
- I am aware of the existence of the risk on my physical appearance to the venue and my camper's participation to the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
- The camper nor anyone in contact with the camper has not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.
- The camper has not, nor any member(s) of my household, traveled by sea or by air, internationally within the past 30 days or visited any any area outside of the tri-county area in the United States that was reported to be highly affected by COVID-19, in the last 30 days.
- The camper, nor any member(s) of my household, had not been diagnosed to be infected of COVID-19 virus within the last 30 days.
Following the pronouncements above I hereby declare the following:
- I am fully and personally responsible for my child's safety and actions while and during thier participation and I recognize that my child may be in any case be at risk of contracting COVID-19.
- With full knowledge of the risks involved, I hereby release, waive, discharge the Island Camps, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
- I agree to indemnify, defend, and hold harmless Island Camps, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.
By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT I AM RELEASING LEGAL RIGHTS THAT OTHERWISE MAY EXIST.
Model/Picture Release Note

At various times the City of Deerfield Beach and/or Island Surf and Sport, inc. videotapes and photographs events for marketing purposes. By entering yourself or your child in the above mentioned City program, you hereby authorize the City of Deerfield Beach and Island Surf and Sport, inc. to reproduce, copy, exhibit, publish, broadcast or distribute any and all such videotapes, audio tapes or photographs. This includes printed & web photos provided to the parents/guardians at the end of camp.
Camp Cancellation Policy

If you have a need to cancel we will try to be as flexible as possible but have set up these guidelines for refunds. Please email all cancellation requests to info@islandcamps.com
- Cancellations received 2 weeks in advance will receive a 90% refund
- Cancellations received 1 week in advance will receive a 50% refund or credit for a future week/day of camp.
- Cancellations received 72 hours -24 hours before camp with a doctors note will receive credit for a future week/day of camp.
- Cancellations after 72 hours before the start of camp will not be credited except with a doctor's note or family emergency
Permission to participate*

Approve
Signature of Parent/Guardian of Camper*

Clear

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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2022/2023 Winter Skate Camp

Join Island Camps for Our One-Day Mobile Skate Camps

Camp Cancellation Policy