Camp Berkeley Nature Camp Registration (June 24-26, 2024)

Number of Campers*

1 Camper ($195)2 Campers ($380)3 Campers ($570)4 Campers ($760)

Camper's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Camper #2 Name (if signing up additional camper)

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Camper #3 Name (if signing up additional camper)

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Camper #4 Name (if signing up additional camper)

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Cell Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*

LIABILITY WAIVER AND INDEMNIFICATION AGREEMENT

RELEASED PARTIES: Berkeley Farm, LLC, Daniel Tyler Castleberry, Lauren Castleberry, Jay Barton Castleberry, and Melissa Castleberry

PARTICIPANT:

In consideration for being permitted to engage in outdoor activities commonly known as “Berkeley Farm Nature Camp” on certain real property owned by the Released Parties and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned, on behalf of myself, my heirs, successors and assigns (or, if the participant on whose behalf this waiver is being executed is under the age of eighteen years of age, the undersigned, as parent or legal guardian of and on behalf of such minor child and his or her heirs, successors and assigns), herebyWAIVES, RELEASES and DISCHARGES the Released Parties from any and all loss, injury or liability which may be sustained by me (or by the minor child) while in, on or upon the real property (including any improvements thereon) owned by the Released Parties, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OR FAULT OF THE RELEASED PARTIES, ANY OF THEIR AGENTS OR EMPLOYEES, OR ANY OTHER THIRD PARTY.

I (or the minor child) further hereby agree to indemnify and hold harmless the Released Parties from any loss, liability, damage, or costs, including court costs and attorneys’ fees that Released Parties may incur due to my (or the minor child’s) participation said outdoor and related activities, whether caused by negligence of the Released Parties or otherwise, to the fullest extent allowed by law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND THAT I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A LEGALLY BINDING RELEASE OF LIABILITY AND THAT I SIGN IT OF MY OWN FREE WILL. I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER OR AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR ON WHOSE BEHALF THIS WAIVER IS BEING EXECUTED.

In the event that I (or the minor child) require medical care or treatment as a result of any activities contemplated by this Agreement, I agree to be financially responsible for any costs incurred for such treatment.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date*

Date

Signature*

PHOTO/VIDEO RELEASE FORM

I grant permission to BERKELEY FARM LLC & BERKELEY FARM NATURE CAMP, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at BERKELEY FARM LLC & BERKELEY FARM NATURE CAMP for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium by BERKELEY FARM LLC & BERKELEY FARM NATURE CAMP. I hereby release BERKELEY FARM LLC, BERKELEY FARM NATURE CAMP, its agents, and its employees from liability for any violation or claims relating to said images or video.

Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Date

My Products*

Registration Fee for 1 Camper Product Image

Registration Fee for 1 CamperThis fee covers registration for 1 camper. By completing this purchase, you agree to the cancellation/refund guidelines listed on our website.

$195.00

Registration Fee for 2 Campers Product Image

Registration Fee for 2 CampersThis fee covers registration for 2 campers. We ask that you only use the discount for siblings within the household. By completing this purchase, you agree to the cancellation/refund guidelines listed on our website.

$380.00

Registration Fee for 3 Campers Product Image

Registration Fee for 3 CampersThis fee covers the registration for 3 campers. We ask that you only use the discount for siblings within the household. By completing this purchase, you agree to the cancellation/refund guidelines listed on our website.

$570.00

Registration Fee for 4 Campers Product Image

Registration Fee for 4 CampersThis fee covers the registration for 4 campers. We ask that you only use the discount for siblings within the household. By completing this purchase, you agree to the cancellation/refund guidelines listed on our website.

$760.00

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

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

Camp Berkeley Registration

Camper Information