Summer Camp Activity Waiver Form

The Cookie Countess is excited to invite your young baker to join us in our kitchen for a fun-filled summer camp, where they'll discover the joy of baking and decorating delicious treats!

Name of the Child*

First NameLast Name

Nickname

Age*

Name of the Parent/Guardian*

First NameLast Name

Parent/Guardian's Phone Number*

Parent/Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Additional Emergency Contact*

NamePhone Number

Does your child have any food allergies, sensitivities or physical limitations we should be aware of?*

Please note: this camp is not suitable for children with allergies or sensitivities related to gluten, dairy, eggs or food dyes.

Is there anything else you feel is important that we know about your child?*

Which week did you sign up for?*

Additional Adults Authorized to pickup my child

NamePhone Number

Assumption of Risk, Release of Liability & Waiver, and Permission to Use Image

By signing this Assumption of Risk, Release of Liability and Waiver, I represent that it is my desire and intent that the child identified above (the Child) participate in the activities of The Cookie Countess, specifically including baking and dessert making camp. I also represent that I have the authority to enter into this agreement on behalf of the Child as the Child’s parent or legal guardian. I acknowledge that the participation of the Child in The Cookie Countess baking and dessert making camp, which includes participating in activities related to preparing and eating food, involves known and unknown risks, including the risk of physical injury, death, and other damage. On behalf of the Child, I expressly and voluntarily assume any and all risks associated with participation in The Cookie Countess baking and dessert making camp and eating the food prepared there. I understand that there are risks inherent in cooking and eating the food prepared, including but not limited to, slips, falls, cuts, burns, choking, food allergy reactions, and other accidents and injuries that may arise from the activity of cooking and eating the food prepared in class. In consideration for the Child being permitted to attend and participate in The Cookie Countess baking and dessert making camp and any and all of the activities that are or might be associated with The Cookie Countess, on the Child’s behalf, I release and further agree to indemnify, defend and hold harmless The Cookie Countess, including its members, managers, officers, owners, employees, agents, contractors, representatives, volunteers, interns, and insurers, from any and all claims, demands, actions, causes of action, lawsuits, expenses, or losses (including attorney fees) whatsoever that could be brought by me, the Child or a third party acting on behalf of the Child or me for acts or omissions related in any way to, or arising out of, The Cookie Countess camp and the preparation of food in that class for consumption. I understand that at any camp, events, or activities of The Cookie Countess the Child may be photographed, filmed, or otherwise have our activities recorded by The Cookie Countess, its employees, agents, or contractors. In further consideration for the Child being permitted to attend and participate in The Cookie Countess camp, I agree to allow the voice, image, and likeness of the Child to be recorded and reproduced by photo, video, film, tape, or any other media, including any electronic or digital media, and that such content may be used and reproduced for any legitimate purpose by The Cookie Countess or its assigns. I agree that The Cookie Countess shall own all copyrights in such content. I hereby waive any and all rights to royalties, commissions, or other compensation, and any and all rights of publicity or privacy, that the Child may have, now or in the future, related to the use or exploitation of such content described above by The Cookie Countess. I understand that this is the entire agreement between The Cookie Countess, their agents or employees, and me, and that it cannot be modified or changed in any way by the representations or statements of any employee, agent, volunteer, or intern of The Cookie Countess. I agree that this Agreement shall be governed and interpreted under Rhode Island law. I acknowledge that I have read and understand this document, which affects the Child’s and my legal rights, and I am signing it on behalf of the Child, as well as his/her heirs and assigns, who will be bound by all of its terms. By signing this form, I agree to the above waiver.

Parent/Guardian Signature