From: [parent’s name] (herein referred to as the PARENT/GUARDIAN)
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Email:
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Phone:
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Regarding: (child's full name)
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Date of Birth
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Allergies
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(Additional children) Regarding: (child's full name)
Date of Birth
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Allergies:
(Additional children) Regarding: (child's full name)
Date of Birth
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Allergies:
(Additional children) Regarding: (child's full name)
Date of Birth
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Month
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Allergies:
Today's Date
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Summer Camp Extended Care Selection
Dino Camp June 8-11 (Ages 3-5)
Dino Camp June 15-18 (Ages 3-8)
Art Camp June 22-25 (Ages 3-12)
Art Camp June 29- July 2nd (Ages 3-12)
1. ACKNOWLEDGMENT AND ASSUMPTION OF RISKS - Informed Consent of Activities.
The PARENT/GUARDIAN acknowledges that their child will have the opportunity to engage in risky activities, which may include tree climbing, hiking on uneven and sometimes slippery or rocky grounds, tool use, fire tending, stick play, and many more activities in all weather conditions that have known and unknown dangers and risks associated with participation, including but not limited to, the risk of minor injuries such as cuts, bruises, and scrapes, insect bites, insect stings, weather associated injuries, and more, as well as the risk of serious injury or death. The undersigned and the participant(s) choose to voluntarily enter upon the premises and property upon which DIRT Outdoor School is conducted, knowing their present condition and knowing that said condition might become more hazardous and dangerous during the time the participant or the undersigned is upon said premises. The undersigned and the participant(s) voluntarily assume any and all risks of loss, damage, or injury that may be sustained by the participant(s) and/or the undersigned while on or upon said premises above. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN
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2. RELEASE AND WAIVER OF CLAIMS
The PARENT/GUARDIAN releases, holds harmless, waives, and fully discharges DIRT Outdoor School from any and all claims, demands, obligations, causes of action and liabilities of any kind arising from or connected to, directly or indirectly, any loss, damage, or injury, including death, that may be sustained by the child participant and/or the undersigned, while upon the premises upon which DIRT Outdoor School is conducted or engaging in DIRT Outdoor School programs. DIRT Outdoor School shall not be obliged to carry insurance on the participant(s) and the existence of insurance shall not change, alter, or increase the liability of DIRT Outdoor School to the participant(s) and the undersigned or affect the terms of this Release. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN
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3. INDEMNITY
The PARENT/GUARDIAN will indemnify and hold harmless DIRT Outdoor School from any damage, loss, liability, legal costs and other expenses that DIRT Outdoor School may suffer or incur by reason of any claims against DIRT Outdoor School. In signing this Release, the undersigned acknowledges: a) That they have read thoroughly, understands completely the terms of this Release, and signs it voluntarily. b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal guardian of the child participant.
E-SIGNATURE OF PARENT/GUARDIAN
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FULL RELEASE
I UNDERSTAND THAT, BY SIGNING THESE RELEASE AGREEMENTS, I GIVE UP IMPORTANT LEGAL RIGHTS, INCLUDING, BUT NOT LIMITED TO, THE RIGHT TO SUE. I UNDERSTAND THAT DIRT OUTDOOR SCHOOL IS RELYING UPON MY FULL RELEASE AND WAIVER OF ALL CLAIMS WHEN ALLOWING MY CHILD TO PARTICIPATE IN DIRT OUTDOOR SCHOOL PROGRAMS.
E-SIGNATURE OF PARENT/GUARDIAN
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Photo/Video Release
I hereby give permission for pictures and/or videos to be taken of my child in the program setting for GENERAL RECORD-KEEPING PURPOSES.
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Yes
No
I hereby give permission for pictures and/or videos to be taken of my child in the program setting for use on SOCIAL MEDIA platforms and OUTREACH materials.
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Yes
No
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