Summer Camp Registration Form

Summer Camp Registration Form

Thank you for your interest in registering your child for the Great Adventure Summer Camp at High Point Urban Adventures! In the following pages, you will select which camp your child will attend, pay the registration fees, and complete all necessary information and release forms. If you have any questions, please contact us at info@highpointyouthranch.org or by phone at 918-595-2875.

Select registrations:

Camp Registration - June 26-30$249.00

Monday-Friday, 8am-4pmAges: 10-16

Quantity

Camp Registration - July 17-21$249.00

Monday-Friday, 8am-4pm Ages: 10-16

Quantity

Before/After Care Registration - June 26-30$25.00

Before Care - 7:30am-8pm After Care - 4-5:30pm

Quantity

Before/After Care Registration - July 17-21$25.00

Before Care - 7:30am-8:00am After Care - 4-5:30pm

Quantity

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

PARENT/GUARDIAN INFO
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Would you like to receive emails from High Point Urban Adventures about special events, discounts, and other important updates?*

YesNo
EMERGENCY CONTACT #1
Name*

First NameLast Name
Relationship to You*
Phone Number*

Area CodePhone Number
EMERGENCY CONTACT #2
Name*

First NameLast Name
Relationship to You*
Phone Number*

Area CodePhone Number

High Point Urban Adventures Challenge Course Assumption of Risk and Release of Liability

All guests of High Point Urban Adventures must read and sign this Assumption of Risk and Release of Liability regardless of their level of involvement in the program activities during an Event. Please read carefully before signing, as this is a binding contract in which you are giving up your right to sue.
I (names listed below referred to as “I” or “Me” understand that by signing this contract (called “Release”), I am releasing High Point Youth Ranch, Inc., doing business as High Point Urban Adventures (“High Point”) and any related entity, and their owners, officers, directors, agents, employees, representatives, successors and assigns (together “Released Parties”) from any liability.

1.       I will be participating in a Challenge Course (sometimes called the “Event”). I understand there are inherent risks involved associated with the Event including but not limited to possible equipment failure, acts of fellow participants, injuries from climbing or walking on cables, logs, ladders, walls, and beams, some of which are forty plus feet above the ground, rappelling, being lowered from a rope, and at times relying on others for my safety. I understand there are other risks that are currently unknown and unanticipated by me. I HEREBY ASSUME SUCH RISKS.

2.       I understand that I have a duty to exercise reasonable care for my own safety and I agree to do so. I declare that I am physically fit to participate in all activities listed in Section 1 above and I will not hold Released Parties responsible if I am injured as a result of my participation in the Event

3.       If I become distressed at any time I will ask for assistance.

4.       I understand that there are limited medical resources near the location of the Challenge Course and that if I am injured, appropriate medical help will be called, but the response time may be delayed due to the location of the Challenge Course. I agree to these conditions.

5.       The Released Parties have made no representation to me implied or otherwise that they can or will perform safe rescue or can render first aid. If I show signs of distress or call for assistance, I would like the assistance of Challenge Course employees and I will not hold Released Parties, their employees or other guests responsible for their actions in attempting the performance of rescue or first aid.

6.       I acknowledge Released Parties are not responsible for any lost or stolen items.

7.       I hereby grant permission for High Point to create and capture audiovisual works including the production of photographs, films, and/or recordings of and from my voice or my appearance (“Likenesses”) by any method of recording during the Event. The Likenesses may be used or reused, published or republished, modified or altered for educational and promotional/advertising purposes in perpetuity (forever).

8.       By signing below, I hereby waive my rights to sue/bring legal action against the Released Parties, whether specifically named or not, and I hereby hold the Released Parties harmless from and against all liability for personal injury, property damage or wrongful death caused by the negligence or gross negligence of the Released Parties, and I assume all risk in connection with the Event, including any risk arising from the maintenance of Event equipment or organization of the Event.

9.       I have carefully read all of this Release, I fully understand its contents and agree to the terms and conditions of this contract on behalf of myself, my heirs, and my personal representatives. This Release constitutes the final and entire agreement between Released Parties and the undersigned. Released Parties make no warranties to me, whether expressed or implied.

10.   I agree that if any portion of this Release is found to be invalid, unlawful, unenforceable, injurious to public health, public morals or confidence in administration of the law or is otherwise found to violate the public policy of the State of Oklahoma, that only that portion shall fail and all other portions shall not be affected and shall continue to be enforceable to the fullest extent permitted by the law. I specifically waive my right to claim this Release is unenforceable and waive unenforceability based on any public policy argument that I could otherwise make or that may be made on behalf of me or my estate.

11.   I have had the chance, if I wanted, to discuss this Release and its meaning with an attorney of my choice. I intend for this Release to be as broad as allowed by the laws of the State of Oklahoma. This Release is made and executed in the State of Oklahoma. This Release shall be subject to, and interpreted by and in accordance with, the laws (but not the conflict of law provisions) of the State of Oklahoma.

12.   I may take a short survey both before and after the Event. I understand that High Point may contact my organization (if applicable) after the Event, then again three and six months later. I understand that data collected will be consolidated in an anonymous manner, studied for research purposes and used for program improvement.

I am signing this Release of my own free will and agree to be bound by it, from the date of my signature for forever into the future.

By signing below, I acknowledge that I have read this Agreement and understand that I am waiving, for myself and my heirs, next of kin, personal representatives, executors and administrators, my right to maintain a lawsuit against High Point or any of the other Released Parties on the basis of any claim from which I have released them herein.

IF I AM SIGNING THIS AGREEMENT AS A PARENT OR LEGAL GUARDIAN OR LEGAL REPRESENTATIVE OF A MINOR UNDER AGE 18, I confirm that I am granting permission for such minor to engage in the Event and that I have discussed the Event and the related risks with such minor and he or she willingly and voluntarily desires to participate in the Event. I further confirm that each of the releases, discharges, indemnifications, certifications, assurances and agreements contained in this Agreement are made on behalf of such minor(s) to the fullest extent allowed by law, and on my own behalf.

The signature below is that of the Adult participant or of the Parent of Legal Guardian of the Minor participant(s) identified below.
Signature*

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High Point Urban Adventures Participant Policies

All participants and observers must read and initial the following policies before attending an Event at the facility. If the participant is a minor, the minor's parents or legal guardian must read and provide the following information to the minor, and the parent or legal guardian shall indicate his or her acceptance of this responsibility by initialing below.
DRESS CODE POLICY

For the protection and safety of all staff and program participants, program participants and chaperones are expected to comply with the following dress code policy:
- Shorts, skirts, or dresses must be of modest length defined as a maximum 6” above the knee of the wearer or not above the fingertip of the wearer with the arm fully extended, whichever is longer.
- Shirts should not reveal the midriff or cleavage at any time. Shirt sleeves should cover the shoulder.
- Clothing should neither be tight nor draw undue attention to the shape of the body.
- Clothing should not reveal the individual’s undergarments.
- Clothing should not contain images or language that are anti-Christian, crude, sexual in nature, promoting the use of alcohol or drugs, or in any other way morally objectionable.
- Program participants are required to wear closed-toe and closed-heel shoes, preferably athletic shoes.
HIGH ROPES PARTICIPANT RESPONSIBILITY

All program participants get the opportunity to participate in all development activities prior to advancing to any high ropes course activities. A "challenge by choice" policy will be followed, where participants are encouraged to experience the high ropes activities, but they are not required.

The high ropes challenge courses are not recommended for guests who are pregnant or have neck, bone or back injuries, high blood pressure, heart problems, recent surgery or extreme fear of heights. A guest will be denied entry if they are under the influence of alcohol, a controlled substance or drug, or any combination thereof.

Participant Requirements:
1. Weigh less than 250 pounds.
2. Remain upright.
3. Connect or disconnect a safety device only at the direction of a staff member.
4. Wear properly fitted & secured harnesses.
5. Secure all loose articles.
6. Wear closed-toe and closed-heel shoes.
7. Enter & exit courses at designated areas.
BEHAVIOR MANAGEMENT

To ensure an enjoyable and safe experience for all campers, High Point's staff manages child behavior. All campers are expected to behave appropriately, and in the event of disruptive behavior, a child may be removed from the group for a time-out. If the disruptive behavior continues, the parent/guardian will be called to help find a solution. If improvement is not realized immediately, the parent/guardian may be asked to remove the child early from the summer camp program and the child may be asked not to return for the day, or for the remainder of the week, depending on the severity of the behavior. No refund will be issued.

CANCELLATION & REFUND POLICY

This policy is specific to the Summer Camp Programs and supersedes the Cancellation and Refund Policies posted on highpointok.org/urbanadventures/policies. If a parent/guardian cancels their camp registration fourteen (14) or more calendar days prior to the event start date, they will be refunded any monies paid towards their registration. If cancellation is less than fourteen (14) calendar days prior to the scheduled date, the registration fees will be forfeited. Camp registration may be transferred to another individual only with the pre-approval of the Camp Director.
Initals*

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Camper #1 - Information Sheet
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Weight*
What grade will this camper be entering in the Fall? *
T-shirt Size*
Does this camper have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the event? *
Does this camper have any allergies?*
Please specify allergies.*
Does this camper carry an Epi-Pen, inhaler or similar device?*
Does this camper have any limited ability or health needs we should be aware of?*
Please specify this camper's limited ability or other health needs.*
Do you have an additional camper?*

YesNo

Camper #2 - Information Sheet
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Weight*
What grade will this camper be entering in the Fall? *
T-shirt Size*
Does this camper have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the event? *
Does this camper have any allergies?*
Please specify this camper's allergies.*
Does this camper carry an Epi-Pen, inhaler or similar device?*
Does this camper have any limited ability or health needs we should be aware of?*
Please specify this camper's limited ability or other health needs.*
Do you have an additional camper?*

YesNo

Camper #3 - Information Sheet
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Weight*
What grade will this camper be entering in the Fall? *
T-shirt Size*
Does this camper have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the event? *
Does this camper have any allergies?*
Please specify this camper's allergies.*
Does this camper carry an Epi-Pen, inhaler or similar device?*
Does this camper have any limited ability or health needs we should be aware of?*
Please specify this camper's limited ability or other health needs.*
Do you have an additional minor?*

YesNo

Camper #4 - Information Sheet
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Weight*
What grade will this camper be entering in the Fall? *
T-shirt Size*
Does this camper have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the event? *
Does this camper have any allergies?*
Please specify this camper's allergies.*
Does this camper carry an Epi-Pen, inhaler or similar device?*
Does this camper have any limited ability or health needs we should be aware of?*
Please specify this camper's limited ability or other health needs.*
Do you have an additional camper?*

YesNo

Camper #5 - Information Sheet
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Weight*
What grade will this camper be entering in the Fall? *
T-shirt Size*
Does this camper have any pre-existing injuries (ankle, back, knees, etc.) that might be aggravated by the event? *
Does this camper have any allergies?*
Please specify this camper's allergies.*
Does this camper carry an Epi-Pen, inhaler or similar device?*
Does this camper have any limited ability or health needs we should be aware of?*
Please specify this camper's limited ability or other health needs.*

High Point Urban Adventures Health Agreement
I UNDERSTAND I SHOULD NOT PARTICIPATE IN HIGH ROPES ACTIVITIES IF I AM:
1. Pregnant;
2. Have a heart condition or problem;
3. Have any pre-existing neck or back injuries, especially with my spine;
4. Have had a recent organ transplant;
5. Weight 250 pounds or more (for zip line only); or,
6. If a doctor has recommended that I do not participate.
My signature below indicates that I have read the above and I have honestly completed all requested information, and if necessary, I have disclosed to the staff any reasons that might affect my safety or the safety of others during participation in the Challenge Course. Further, I certify that the above information is complete and accurate. By signing below, I agree to be mindful of my body, its needs and its limitations during participation in the Challenge Course and to communicate with High Point Urban Adventures staff if I am unable to complete any portion of the Challenge Course safely.
Signature*

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Summer Camp Registration Form

High Point Urban Adventures Challenge Course Assumption of Risk and Release of Liability

High Point Urban Adventures Participant Policies

DRESS CODE POLICY

HIGH ROPES PARTICIPANT RESPONSIBILITY

BEHAVIOR MANAGEMENT

CANCELLATION & REFUND POLICY

Camper #1 - Information Sheet

Camper #2 - Information Sheet

Camper #3 - Information Sheet

Camper #4 - Information Sheet

Camper #5 - Information Sheet

High Point Urban Adventures Health Agreement