We invite you to complete the Camp Application Form in full so we can thoughtfully prepare for your participant’s experience. Please provide accurate information regarding support needs, medical considerations, emergency contacts, and funding source. This ensures our team can determine appropriate staffing, group fit, and overall readiness for a safe and successful camp day. Submission of the application does not guarantee placement, but it allows us to begin the review process and follow up with next steps promptly.

I, the undersigned, hereby declare and affirm that:

I am the parent/legal guardian of the camper named above (hereinafter referred to as "Child"), who is under my care and responsibility.

I hereby consent and give authority to the participation of my Child in the scheduled activities of the Camp, and all other activities which is supervised and customarily associated with its group.

I hereby declare and affirm that my Child is physically fit to take part in the Camp's activities and my Child has no known illness or adverse medical condition that would render him/her unfit to participate therein, other than the information specified in the medical information above.

I shall immediately advise the organizers in writing, should I discover any illness, adverse medical condition, or any other physical challenges that would render my Child unfit to participate in the recreational and sporting activities of the Camp.

I shall notify the organizers immediately in case I revoke my consent to the Camp for this event.

Authorization for Medical Treatment

I understand that in case of medical emergencies involving my Child, I shall be notified right away. In case any of my provided contact information is unreachable, I authorize the organization to call the doctor indicated above. In case that the doctor is not available, I authorize the organizers to call any doctor to provide the necessary medical attention to my child.

I understand that the camp shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.

Media, Consent, Release, and Waiver

I hereby give consent to LEAPS Services (the “organization”) to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself or my child or children (if applicable) to use in any public media, including radio, television, internet, social media, print or in any of the organization’s or its partners’ publications, productions, or posts.

I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization.

I hereby waive any rights or interest in the images or recordings, as contemplated in this release.

I acknowledge that this consent to use images and/or recordings is being made solely for the benefit of the organization and comes without any expectation of monetary compensation or other benefit to me. To the extent that any benefit accrues or might accrue to the organization from the use of images or information, I hereby and forever waive any interest in or claim to such benefits.

I hereby release and forever discharge the organization (including without limitation all corporate affiliates and officers, directors, trustees, donors, employees, agents and volunteers) from any and all claims, liability, actions, suits, demands, costs, expenses or indebtedness arising out of, related to, or in any way connected with the use of images and materials described herein, and I hereby waive all rights and interest in and to such information and materials.

I further acknowledge that there is no guarantee that any or all of the participants’ images or recordings will be used in any released media.

I have been informed that this authorization is voluntary and is subject to revocation at any time, except to the extent that action has been taken in reliance thereon, by notifying the organization in writing at:

info@leapsservices.com

Please click "Submit" below to complete registration.