Kids Naturally Participant Registration School Year 2024/25

Are immunizations up to date?*

YesNo

Date of last tetanus shot:*

Are there any activities your child should be restricted from?*

Are there any physical, mental or other conditions that would require special attention or medication while at Kids Naturally?*

List all medications, both prescribed and over the counter. *

List any allergies (ex. bees, peanuts, dairy):*

Does your child have Asthma?*

YesNo

If yes, please list medications used to control symptoms:*

I, the undersigned (the “Guardian”), hereby give permission for my child (the “Minor”), to participate in the camps, events, programs, and activities (collectively, the “Programs”), operated or conducted by Kids Naturally LLC (“Kids Naturally”), at The Thoreau Club in Concord Massachusetts. In consideration of Kids Naturally permitting the Minor to participate in the Programs, the undersigned, on behalf of the Minor, hereby agrees to the following:

Acknowledgment and Assumption of Risk. The Guardian hereby agrees, on behalf of the Minor and the Minor’s heirs and personal representatives, to fully and forever discharge and release Kids Naturally and its officers, managers, members, employees, contractors, insurers, agents, and representatives (collectively, the “Released Parties”), from any and all claims the Minor may have currently or after the date of this Release, for any injury, temporary or permanent disability, death, damages, liabilities, expenses, costs, and/or causes of action (collectively, “Injuries”), in any jurisdiction, attributable or relating, in any manner, to the Minor’s participation in the Programs, whether caused by the negligence of the Released Parties or by any other reason. The Guardian understands and acknowledges that this Release is intended to be, and is, a complete release of all claims to the fullest extent allowed under applicable law, and discharges Kids Naturally from any liability or claim that the Guardian and the Minor may have against Kids Naturally that may result from activities commonly associated with playing in the woods, including, without limitation, running, hiking, log/tree climbing, wading in knee-high water, use of tools, poison ivy, animal/insect bites, ticks, and bee stings. The Guardian hereby agrees, on behalf of the Guardian, the Minor, and their respective heirs and personal representatives, (i) not to make or assist in any type of legal or equitable claim against any of the Released Parties with respect to any Injuries incurred by the Guardian or the Minor, whether or not arising through the negligence, omission, default, or other action, of anyone affiliated with Kids Naturally, including other participants in the Programs; and (ii) to indemnify, defend, and hold harmless the Released Parties from all Injuries (including attorneys’ fees) waived hereunder. The Guardian acknowledges that no representations or warranties are being made by Kids Naturally and that the Guardian is not relying on any such purported representations or warranties.

Insurance. The Guardian acknowledges and understands that Kids Naturally disclaims any compensation or liability related to the Programs. It is the Guardian’s responsibility to provide or obtain medical insurance coverage for the Minor. Any costs of medical treatment provided to the Minor will be the sole responsibility of the Guardian of the Minor.

COVID-19. Kids Naturally takes reasonable preventative measures to decrease the spread of COVID-19 as mandated by the Commonwealth of Massachusetts. Kids Naturally cannot guarantee, however, that the Guardian and/or the Minor will not become infected with COVID-19 in connection with the Programs. The Guardian hereby acknowledges that participation in the Programs could increase the chance of the Guardian and/or Minor contracting COVID-19, and voluntarily assume such risk.

Representation of Guardian Status. The Guardian represents and warrants to Kids Naturally that the Guardian is the parent or legal guardian of the Minor, and has full right, power, and authority to execute this Release on the Minor’s behalf.

I CERTIFY THAT I HAVE READ THIS RELEASE, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

Name of Child ("The Minor") Name of Child *Age Age*

Signature of Guardian*

Emergency Medical Care Consent

Kids Naturally will use its reasonable efforts to contact the Guardian in the case of an emergency. In the event of illness, injury, and/or accident, the Guardian authorizes Kids Naturally and its employees to act on the Guardian’s behalf, including, without limitation, to approve any and all non-emergency or emergency treatment it considers necessary in its discretion, and authorizes Kids Naturally to sign any and all medical releases or required forms on the Guardian’s behalf to the extent permissible under applicable law. The Guardian hereby releases and forever discharges the Released Parties from any claim whatsoever that may arise on account of any first-aid treatment or other medical services provided to the Minor, including, without limitation, administering EpiPens and inhalers, CPR, use of sunscreen/bug spray, and/or applying bandages. The Guardian represents and warrants to Kids Naturally that the Minor has no conditions that would make participation in the Programs unsafe, or has informed Kids Naturally of any underlying conditions and disclaims any liability arising out of the pre-existing condition.

Parent/Guardian Initials:*

Topical Medication Consent

I, the above signed (the "Guadrian"),hereby authorize Kids Naturally LLC to apply the following over the counter topical medications as needed as indicated in the above medical care consent:

SPF 40 Sun ScreenInsect Repellent60% Alcohol Hand SanitizerPoison Ivy Treatment Soap

Parent/Guardian Initials:*

Emergency Epinephrine Use Consent

In the event that my child has allergies, I will provide the appropriate medications and documentations, including an emergency epinephrine dispenser where applicable. I, the parent or legal guardian of the child named above, give consent for Kids Naturally to dispense emergency prescribed epinephrine to my child in the event of an allergic reaction.

Please choose an option below*

Parent/Guardian Initials:*

Photo Release

Parent/Guardian Initials:*

All of the above information is true and accurate to the best of my knowledge.

Signature*

Kids Naturally Participant Waiver

Participant Information

Parent/Legal Guardian Information

Emergency Contact Information

Health Information

Consent Information

Release and Waiver of Liability Agreement for participation in Kids Naturally