STEAM Summer Camp Registration 2025

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the Black River Innovation Campus (BRIC) during the selected summer camp. In exchange for the acceptance of said child’s candidacy by BRIC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless BRIC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

I acknowledge that BRIC has professionals trained in CPR/First Aid on campus during the STEAM summer camps, and that there are no licensed medical professionals (such as LPNs, nurses, or doctors) on site.

In case of injury to said child, I hereby waive all claims against BRIC, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all STEAM activities.

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Black River Innovation Campus and its affiliates including Directors, Counselors, and BRIC Team Members to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered summer camp.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photo Release and Authorization

As Parent and/or Guardian of the named camper, I hereby grant permission to BRIC and its affiliates to use my child's image and likeness in photographs, videos, and other media for promotional purposes.

I understand and agree to the following:

Release of Rights: I grant BRIC the irrevocable and unrestricted right to use and publish photographs and/or videos of my child, taken during BRIC summer camp activities, for use in any promotional materials, including but not limited to, websites, social media, brochures, advertisements, and press releases.

Identification: I understand that my child may be identified by name, age, and grade level in conjunction with the use of their image.

No Compensation: I waive any right to inspect or approve the finished product wherein my child's likeness appears. I understand that my child will not receive any compensation for the use of these materials.

No Copyright Claim: I acknowledge that all photographs and videos taken by BRIC or its representatives are the property of BRIC and its affiliates, and they may copyright, use, and publish the same in print and/or electronically.

Release of Liability: I release and discharge BRIC and its representatives from any and all claims and demands arising out of or in connection with the use of my child's image, including but not limited to any claims for defamation, invasion of privacy, or infringement of moral rights.

Duration: This release shall remain valid indefinitely and apply to all images taken during my child's participation in BRIC summer camp activities.

Minors: If my child is under 18 years of age, I certify that I am their parent or legal guardian and have the authority to grant the permissions and rights outlined in this release form.

Equipment Handling Notice and Authorization

As Parent and/or Guardian of the named camper, I hereby acknowledge that during my camper's participation in BRIC's STEAM summer camps, they will handle any and all equipment provided to them with respect and care.

I understand and agree to the following:

The named camper will use the equipment provided to them responsibly and only for its intended purpose.

The named camper will report any accidental damage or malfunction of equipment immediately to a camp counselor or instructor.

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.