-Wavier of Liability
-Health History and Examination Form (You will get a package after registered with this application)
Discrimination Policy: Camp Taloali does not discriminate in employment or in camp participation on the basis of gender, gender identification, religion, ethnicity, physical or mental disability, sexual orientation, place of origin, immigration status, color, or race.
Person Designated to Take Camper TO & FROM Camp If different from Parents/Guardian
If yes, we will contact you shortly with instructions for the monthly payment plan.
I hereby give my permission to Camp Taloali to call a doctor or emergency medicial service and for the doctor, hospital, or medical service to provide emergency medical or surgical care for my child should an emergency arise. It is understood that Camp Taloali will make a conscientious effort to locate parents, and/or any emergency contact listed on this form any action is taken. I/We will accept the expense of medical or surgical treatment.
I/We herby to give our permission for photographs to be taken of our child during Camp Taloali activities, and for publication. (i.e brochure, website, etc) use reasonably related to the positive promotions of the Camp Taloali programs. This includes being used on the Camp Taloali social media.
I/We hereby give permission for my child to go on field trips away from Camp Taloali's premises, whether on foot or by authorized vehicle with a driver and a chaperone. I give permission for my child to participate in all Camp Taloali events with following expectation.
I/We agree to indemnify, hold harmless, and defend Camp Taloali and their respective employees, agents, and representatives from and against any and all liabilities, claims, or demands which may be asserted against any or all of them in connection with our applicant's participation in Camp Taloali. This includes holding Camp Taloali harmless for any injury which may occur to our applicant while traveling to the Camp Taloali's facility, or while returning from the Camp Taloali facility to go home.
Enclosed is current Health Information for First Name* Last Name*
Notice of Privacy Practices:
I understand that the Camp Taloali will use and disclose health information about me.
I understand that my health information may include information received by CAMP TALOALI in the form of written or electronic records or spoken words, and may include information about my health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, and similar types of health related information.
I understand that I have the right to receive and review this written description how Camp Taloali will handle health information about me. This written description describes the use and disclosures of health information made and the information practices followed by the staff and office personnel of Camp Taloali and my rights regarding my health information.
I understand that I have right to ask that some or all of my health information not be used or disclosed in the matter described in this notice of Privacy Practice, and I understand that Camp Taloali is not required by law to agree to such requests.
By signing below, I agree that I have reviewed and understand this information above.
HIPAA Compliance 2007. Feel free to make a copy of this form for your files. These forms were developed by Upward Bound Camp and we have their permission to use this form.
WAIVER OF LIABILITY/ASSUMPTION OF RISK
Special to COVID-19 Pandemic and Wildfire Ash
In consideration of attending and/or volunteering at camp and participating in recreational activities and services at Camp Taloali, including any services provided by any agents, officers, volunteers, subcontractors, and/or independent contractors of Camp Taloali (collectively referred to as “Camp Taloali”), I hereby agree to release, indemnify, and discharge Camp Taloali on behalf of myself, my spouse, my children, my parents, my heirs, and assigns, and personal representatives, and state as follows:
1. I acknowledge that camp participation at Camp Taloali during the COVID-19 pandemic may expose me to COVID-19, and to ash from recent wildfires. I understand that such risk cannot be eliminated and elect to participate despite these risks and agree to follow posted health regulations.
2. I acknowledge that recreational activities such as horseback riding, rock climbing, scuba diving, archery, disc golf, fishing, swimming, rafting, high and low ropes, biking, etc., that Camp Taloali may provide, entail known and unanticipated risks that could result in physical, mental, or emotional injury, paralysis, damage to property, or even death, to me or third party persons. I understand that such risk cannot be eliminated because of the essential nature of the camp environment.
3. I expressly agree, accept, and assume all the risks existing from participating in recreational activities. My participation in any and all of these activities is voluntary and I elect to participate despite the nature and inherent risks of such activity.
4. I hereby voluntarily release, discharge, and agree to indemnify and hold harmless Camp Taloali of any and all claims, demands, or causes of action that are in any way connected with participation or use of equipment or facilities of any of the contractors or sub-contractors of Camp Taloali, including claims such as, but not limited to the negligent acts or omissions of Camp Taloali.
5. I agree to indemnify and hold harmless Camp Taloali from all costs and damages, including any attorney’s fees or costs incurred by Camp Taloali in defending any such demands, claims, or lawsuits.
6. I certify that I have adequate medical insurance to cover any and all damage I may suffer while participating, or that I agree to pay the cost of any such injury, illness or damage that may result from injury in the above activities.
7. In the event that I file an action against Camp Taloali, I agree that the State of Oregon will have exclusive jurisdiction over this matter and the subsequent laws of the State of Oregon shall apply.
I hereby acknowledge that I have read this entire document and I have had the opportunity to consult with an attorney and I understand this agreement and agree to be bound by its terms.
PARENT/GUARDIAN ADDITIONAL INDEMNIFICATIONIn consideration of blanks* (a minor and/or legal ward) being allowed to participate in Camp Taloali activities, I further agree to indemnify and hold harmless Camp Taloali of any and all claims and demands which are brought on behalf of the above-name minor and/or legal ward) and which may be in any way connected with the minor and/or legal ward participating in such activities.
Camp Taloali is committed to protecting its campers and staff from bullying (which includes harassment and discrimination) for any reason and of any type. The Camp Taloali Board believes that everyone is entitled to a safe, equitable, and positive camping experience. Bullying will be just cause for dismissal from camp or disciplinary action.
"Bullying" means inflicting physical hurt or psychological distress on a camper or staff member. It is further defined as unwanted purposeful written, verbal, nonverbal, or physical behavior, including but not limited to any threatening, insulting, or dehumanizing gesture that has the potential to create an intimidating, hostile, or offensive camping environment or cause long term damage; cause discomfort or humiliation; or unreasonably interferes with the individual’s camping participation, is carried out repeatedly and is often characterized by an imbalance of power.
Bullying may involve, but is not limited to:
1. harassment due to disability, sexuality, religion, socioeconomic status, ethnic background, or other factors with the impact of causing emotional or physical harm.
7. physical violence
9. unwanted teasing
10. public humiliation
11. destruction of camp or personal property
12. social exclusion
13. rumor or spreading of falsehoods.
14. incitement or coercion
15. any cyber use (phone texting or voice, computer, videophone) that causes emotional or physical harm.
Expectations: Camp Taloali expects everyone to treat each other positively and with dignity and respect. Bullying of any kind is prohibited.
Training: During orientation and training prior to camp, all staff members will be trained in the Bullying Policy. Families of campers will be sent of a copy of the policy in advance of camp attendance and will be encouraged to instruct their children about the policy.
Reporting an act of bullying: The camp director/administrator is responsible for receiving oral or written complaints alleging violations of this policy. A board member may also receive the complaint. Any campers (and/or parent or staff member on that camper's behalf) who believes he/she/they or another camp member is victim of bullying is strongly encouraged to report the incident(s) in writing to the camp director/administrator or a board member. Camp staff who observes an act of bullying is required to report it. The staff person is required to then report, in writing, any allegations of bullying or violations of this policy to the director/administrator or board member. Failure to report bullying by staff will result in discipline. Complaints will be filed as soon as possible after the alleged incident.
Bullying Complaints and Resolution:
Informal resolution - where the camp director/administrator, along with the alleged victim, and the accused/student may agree to informally resolve the complaint. Documented interviews of the victim, alleged perpetrator, and witnesses are conducted privately separately, and are confidential. Each individual (victim, alleged perpetrator and witnesses) will be interviewed separately, and at no time will the alleged perpetrator and victim be interview together. Each party's agreement to informal resolution must be in writing. The incident and the resolution must be documented.
Formal resolution - where investigation of a reported act bullying is conducted by the camp director/administrator and at lease one board member. If one of them is accused, and another board member will be assist in the investigation. Documented interviews of the victim, alleged perpetrator, and witnesses are conducted privately separately, and are confidential. Each individual (victim, alleged perpetrator and witnesses) will be interviewed separately, and at no time will the alleged perpetrator and victim be interview together.
If the act is determined to be a possible criminal act, it will be referred to the appropriate law enforcement agency.
Once a resolution is established parents will be promptly notified of any actions is being to taken to protect the victim.
Disciplinary actions: Consequences and appropriate interventions for campers who commit acts of bullying may range from positive behavioral interventions to dismissal from camp. A staff person who commits acts of bullying will be disciplined which could result in termination of employment/volunteer status. All steps necessary to protect the victim from further violations of this policy will be taken.
Retaliation Prohibited: Retaliation against any individual who has made a bullying complaint or any individuals who has testified, assisted, or participated, in any manner, is an investigation is prohibited.
Signature of camper and parent/s that the Bullying policy has been read and discussed and the camper understands this policy and expectation of all campers and staff.