Overview:

Please fill out one form per camper, this form should take you 20 min to submit, you will be able to save and return

Table of Contents:

• General Info
• Photo Release
• Cabin Preference
• Dietary Needs
• Community Agreements
• Health Information
• Consent Waiver
• Optional Information

 

You will need the following documents to complete this form

• Health Physical from the past 18 months
• Completed Health Physical form (or similar provider provided form)
• Vaccination History
• Medical Insurance Card

 

Rowe does not share information about campers without specific permission. Sometimes other adults, such as a grandparent or therapist may wish to talk to Rowe about your camper, ask questions or make a payment on your behalf. Please list anyone else Rowe may share information about your camper with.

As Part of The Rowe Center's ongoing mission to create a welcoming environment for all young people, Rowe offers, masculine identifying (Boys Cabin), feminine identifying (Girls Cabin), nonbinary (Gender Neutral Cabin). All Cabins are staffed by counselors that share the above identities and have separate bathroom and bathing facilities.

Summary:

On occasion, Rowe will use photographs and videos taken over the summer in various Rowe publications such as our website, Facebook page and catalog. We do not publish any identifying information about the campers in these photos. This form is asking for your permission do that.

 

Full Text:

In consideration of participation in {myCamper69}/Rowe Center activities, I hereby consent to the use of any photographs/film/videotape/sound recording made of the camper listed on this camp application, by employees, staff and volunteers of {myCamper69}, and I irrevocably assign all rights in the same to those acting with its permission, for the purpose of illustration, publication, or broadcast in connection with the work, advertising, and promotion of Camp Name and Rowe Center, including, without limitation, websites and pages on social networking websites (e.g. Facebook, Instagram, etc.), for use in Camp yearbooks, editorial, educational, promotional, and advertising purposes, for the solicitation of contributions, and for any other purpose in furtherance of the objectives of {myCamper69}/Rowe Center, without payment to me or my child. Except as otherwise set forth, below, {myCamper69}/Rowe Center will not publish the name of the camper. I have read the foregoing release and authorization before affixing my signature and warrant that I fully understand the contents thereof. I hereby waive all rights and release {myCamper69}/Rowe Center from and shall neither sue nor bring any proceeding against any such parties for, any claim or cause of action, whether now known or unknown, for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use of the Pictures. I agree that there shall be no obligation to utilize the authorization granted by me hereunder. The terms of this authorization shall commence on the date hereof and be without limitation.

Note: Rowe prides itself on providing a wide variety of food options and encourages campers to try new things. Rowe is not able to guarantee food preferences. Although every effort will be made to avoid cross-contamination, food is prepared in a shared kitchen.

Community Agreements

Rowe Camp, founded in 1924, is located in a small New England town in the Commonwealth of Massachusetts. The camp is affiliated with the Unitarian Universalist Association, which in 1984 adopted a revised set of principles, the first four of which affirm and promote:

The inherent worth and dignity of every person;
Justice, equity and compassion in human relations;
Acceptance of one another and encouragement to spiritual growth;
A free and responsible search for truth and meaning.

We believe in these principles. Our goal is to share them with young people by emphasizing individual freedom of choice within a framework of responsibility and respect for the community.

You agree that you have read and will uphold the standards laid out in the community agreement for your camp level.

You undertand that failure to uphold the standards may result in consiquinces up to and including being sent home.

Please have your health care professional complete and sign this form

Physician provided forms are also ok.

Notes:

• Click Here for a more information about vaccination requirments.
• The State of Massachusetts requires that all camps provide the following informational bulletin on meningococcal disease:
  Meningococcal Disease and Camp Attendees: Commonly Asked Questions (PDF)

Summary:

Rowe strives to create the safest experience possible for campers and staff. This may include random covid-19 testing. No organization, including The Rowe Center can guarantee a 100% Covid free environment. You understand the risks inherent with camp.

 

Full Text:

On behalf of myself or my minor child, as applicable, I understand, affirm, and agree to the following:

I understand that The Rowe Center will provide government-mandated guidance to me about the program’s hygiene and health practices related to COVID-19, and I agree to comply. 

I will follow any and all local, state and federal requirements or advisories, including CDC guidance, for preventing the spread of COVID-19. These guidelines include (but are not limited to) quarantining if I have been exposed to someone with COVID-19 and isolating if I have tested positive for COVID-19 or have symptoms of COVID-19.

If I experience any symptoms of illness or have been around others that are ill, I will refrain from participating in the program activities for the time period recommended by the CDC or other applicable authorities for self-quarantine and/or as instructed by The Rowe Center. 

I represent that currently, to the best of my knowledge, I, and everyone in my household (if applicable), am healthy and symptom-free, with no known exposure to COVID-19 now or during the previous 14 days.

When I participate in the program each day, it is because to the best of my knowledge I am healthy and symptom-free with no known exposure to COVID-19, and that the same is true for everyone in my household. 

In the event that I, or one of my housemates, contracts COVID-19, I hereby grant authority to The Rowe Center to inform parties identified as necessary by the Commonwealth or other relevant government authority of required information (including my identity), and to notify The Rowe Center program participants and staff (in which event The Rowe Center will not disclose my name to the community but will instead make best efforts to maintain confidentiality), and I will work with The Rowe Center toward that end.

I understand the COVID-19 situation is fluid and subject to change per federal, state, or local authorities and guidance, as well as The Rowe Center’s program needs.

I understand failure to follow The Rowe Center’s COVID-19 safety guidelines may result in my immediate termination from the program.

5. On behalf of my child, I hereby agree to hold harmless The Rowe Center and its employees and volunteers from any liabilities and obligations which I may have against them including, but not limited to, sickness or death caused by the COVID-19 virus or any other communicable disease, or for any loss of personal property that my child may suffer while participating in the Rowe Center program, except in the case of gross negligence by the Rowe Center.

I acknowledge that such risks exist, and I hereby agree on behalf of my child to assume such risks. I, the parent/legal guardian of the named camper, have read, understood, and agree to the above.

Summary:

The information you provided is accurate, your camper is healthy enough for camp and should something happen Rowe has permission to provide medical treatment on your behalf.

 

Full Text:

The health history provided in this application is correct as of today’s date, so far as I know, and the camper herein described has permission to engage in all prescribed camp activities except as noted. I certify, to the best of my knowledge, that the camper does not have any contagious or communicable disease or condition. I, as parent/guardian, am responsible for any changes or updates to medical conditions, medications, and restrictions added or removed between the dates of submitting this application and the beginning of camp. I understand that The Rowe Center is not responsible for illness due to previous injuries, poor health conditions, or illness incidental to attending camp.

I hereby give permission to the camp medical personnel to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests for the camper. If there should be an emergency while the camper is at camp, I authorize treatment by The Rowe Center staff. I authorize The Rowe Center staff to select and designate emergency medical personnel, nurses, physicians, and/or surgeons to furnish emergency medical services, should it be necessary, and to arrange transportation and admittance to a hospital in case of emergency. In the event I cannot be reached in an emergency, I hereby give permission to the medical staff selected by The Rowe Center staff to hospitalize, secure and administer proper treatment, and to order injection, anesthesia and/or surgery for the camper as named above. I agree to the release of any records necessary for insurance purposes. This authorization shall remain effective through the last day of camp, unless sooner terminated in writing.

Summary:

No activity is 100% risk free, you understand that participation involves risk. Your camper is attending camp voluntaraly and is able to participate in camp activities. You understand and accept the risks involved.

 

Full Text:

I affirm that my participation in {myCamper69} is entirely voluntary and understand that participation in {myCamper69} involves a risk of injury due to certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from minor injuries such as scratches, bruises, and sprains, to catastrophic injuries, including death. I understand that if I have questions about possible hazards, it is my responsibility to seek additional information from {myCamper69} staff prior to signing this Form. I also understand that, despite safety precautions, neither {myCamper69} nor UNITARIAN-UNIVERSALIST ROWE CAMP AND CONFERENCE CENTER INC. (hereinafter, “Rowe Center”), can guarantee that I will not be injured. I agree to assume these risks. 

 I understand that the best way to make sure that I remain safe and avoid injury is to follow the rules, regulations, and instructions of the staff of {myCamper69}. I agree that I will learn and obey all the rules and regulations and will follow all instructions of the staff of {myCamper69}. 

PARENT/GUARDIAN AGREEMENT AND RELEASE

I, {nameOf341} the parent/guardian of {campersLegal} hereby give permission for {campersLegal} to engage in all programs and activities of {myCamper69}, except as noted below.  I affirm that attending {myCamper69} is voluntary. I understand and acknowledge that attending {myCamper69} may involve certain risks above and beyond the control of {myCamper69} and/or its representatives and agents, including Rowe Center and/or its representatives and agents, including their current and former officers, directors, employees, agents, affiliates, volunteers, successors, and assigns, (hereby “Released Parties”). I do hereby and forever release, acquit, discharge and covenant to hold harmless the Released Parties from any and all actions, causes of action, claims, demands, damages, loss of service, loss of consortium, expenses and compensation on account of, or in any-way growing out of, any and all personal injuries and property damages, whether based in tort, negligence, statute, contract or otherwise, including, but not limited to, accidents, injuries, catastrophic injuries, emergencies, death, exposure to reckless conduct of other persons, including campers, volunteers and visitors, natural disaster, world events, pandemics, including but not limited to COVID-19, terrorism, and/or negligence of medical personnel, suffered by my child/ward or caused by my child/ward, which may arise at any time during {myCamper69}, and which I/we may hereafter have, either before or after my child/ward has reached majority. Together with my child/ward, I/we further promise to bind ourselves, jointly and severally, to reimburse to the Released Parties any sum of money which they have been compelled to pay, because of any injury or damage, or for any reason, on behalf of my child/ward/myself while at {myCamper69}.

I understand that there are risks inherent in the activities my child/ward will engage in at {myCamper69} (some of which are described above) which may cause serious injury or even death. I also understand that, despite safety precautions, neither {myCamper69}, Rowe Center, nor any of the Released Parties can guarantee that my child/ward will not be injured. My child/ward and I are willing to assume these risks. To minimize the risk, I have instructed my child/ward to obey all the rules, regulations and instructions of {myCamper69}.

ASSUMPTION OF RISK, WAIVER OF LIABILITY, RELEASE & AGREEMENT NOT TO SUE: 

In consideration for permitting me/my child/ward to participate in the Camp, I voluntarily agree, for myself, my heirs, executors, and administrators, to the following: 

TO THE TERMS OF THE AGREEMENT AND RELEASE AND PARENT/GUARDIAN AGREEMENT AND RELEASE STATED ABOVE.

TO ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, OR PERSONAL INJURY, that may be sustained by me/my child/ward, and/or any loss or damage to property owned by me/my child/ward, as a result of or related to attending, and/or traveling to or from, {myCamper69}. 

TO RELEASE, WAIVE, HOLD HARMLESS, DISCHARGE, & AGREE NOT TO SUE the Released Parties named above, from any and all liability, claims, actions, demands, expenses, attorneys fees, breach of contract actions, breach of statutory duty, and/or other duty of care, warranty, strict liability actions, and causes of action whatsoever, that my child/ward/I might now have or may acquire in the future, more fully described above, arising out of or related to any loss, damage, and/or injury, including death, that may be sustained by me/my child/ward, or to any property belonging to me/my child/ward, while traveling to or from, and/or attending {myCamper69}. 

TO THE TERMS OF THE BEHAVIOR EXPECTATION AGREEMENT.
I have reviewed CAMP NAME Behavior Expectations with my child/ward and understand and agree that the terms. We acknowledge that the Camp Director, in his or her discretion, reserves the right to send campers or volunteers home if the Behavior Expectations are not followed. 

THAT IF ANY TERM OF THIS RELEASE IS held by a court of competent jurisdiction to be invalid or unenforceable, then this Release, including all of the remaining terms, will remain in full force and effect as if such invalid or unenforceable term had never been included. 

THAT THIS RELEASE SHALL BE GOVERNED BY AND CONSTRUED in accordance with the laws of the Commonwealth of Massachusetts. I agree that the parties will use reasonable efforts in good faith to discuss and attempt to resolve any dispute arising under this Agreement, Release, and Waiver of all Claims as soon as practicable and without the necessity of any formal proceeding.  I agree that if the parties fail to resolve the dispute within a reasonable time, and the dispute does not involve a claim of breach of the Rowe Center’s confidentiality or intellectual property rights, either party may request in writing that the parties enter into mediation.  I agree that the parties will hire and share the costs of a mediator, and will exchange relevant information and set a date for negotiations.  Such mediation shall proceed in accordance with the mediation rules of the American Arbitration Association or any other rules mutually agreeable to the parties.  I agree that all negotiations will be conducted in strict confidence and without prejudice to the rights of the parties in any future legal proceedings.  I agree that, unless required by law or compelled by authorities, the mediator, the parties, counsel, and any other participants will be prohibited from divulging outside of the mediation any oral or written information disclosed by the parties or by witnesses in the course of the mediation.  Nevertheless, parties and their counsel may disclose information obtained at the mediation session to necessary members of their respective organizations and to insurance representatives, who shall also be bound by the confidentiality provisions of this Agreement, Release, and Waiver of all Claims.  I agree that neither party may commence legal proceedings under the jurisdiction of the courts until after the parties have engaged in mediation and, after at least thirty (30) days, have failed to reach a settlement.  I agree that if the parties reach a settlement, it will be reduced to writing and, once signed by each of the parties, will be binding on the parties.  

ACKNOWLEDGMENT 
We acknowledge and verify that we have reviewed the application, and to the best of our knowledge, the information provided on the application is accurate.

In addition to all of the terms and conditions stated above, I further agree, certify and acknowledge that I am the parent or legal guardian of the minor child, that I have the legal authority to execute this Release and Waiver of All Claims on behalf of my minor child and that I hereby give my permission for my minor child to participate in the activities.

By signing below, we acknowledge that we have read, understand and agree to the terms outlined above, and that we fully understand the risks associated with participation at {myCamper69}, and the consequences of signing this Agreement/Waiver knowingly, freely and willingly. I understand that my typed or e-signature, below, is binding and shall be considered to be the same as my handwritten signature for the purposes of legal validity, enforceability, and admissibility.