Camp Berkeley Registration

Parent/Guardian Information

Emergency Information (please list another person--in addition to parents/guardians listed above--who could be contacted in the event of an emergency).

LIABILITY WAIVER AND INDEMNIFICATION AGREEMENT

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

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.

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.

PARENTAL CONSENT & AUTHORIZATION FOR TREATMENT 

I recognize that my child will be outside and active for a large portion of the day. I recognize that though all care will be taken to ensure my child's safety and wellbeing, camp activities, by their nature, carry the risk of injury.  

I do hereby grant permission for staff at Berkeley Farm Nature Camp and Berkeley Farm LLC to secure such medical aid and hospital services as the staff deem necessary for the child/ren noted above in the event s/he should sustain an injury or illness while attending camp. Should a serious medical problem arise, and I cannot be contacted, the camp and staff has my permission to secure medical and hospital services as necessary and to take my child to an emergency room for treatment. I have also indicated on my child’s camp registration form any medical information of which the camp should be aware in consideration of the child's physical and mental wellbeing. I hereby release Berkeley Farm Nature Camp, Berkeley Farm LLC, and all camp counselors and independent contractors from any responsibility arising from a medical emergency. 

In the case of injury or illness, the camp directors will determine if and when the child's parents will be notified depending on the severity of the incident.  Minor injuries and illnesses that can be treated by a staff member and do not prevent the camper from participating in most camp activities (such as a scraped knee or upset stomach) will not require a phone call to a parent/guardian.  Parent/guardian will be informed of the injury or illness when they pickup their camper at the end of the day. 

Moderate and major injuries or illnesses (such as strained or broken bone, fever, vomiting/diarrhea) will require a phone call to the parent or guardian and for the camper to leave camp.

I give permission to Berkeley Farm LLC and it's independent contractors to apply insect repellent and sunscreen on my child as needed for camp activities.  I agree to supply insect repellent and sunscreen for my child for the duration of camp.  I understand that Berkeley Farm LLC will not supply my child with insect repellent and sunscreen.  

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.