CFD Kid's Summer Camp Registration Form & Waiver

Please submit a seperate form per child. This camp is for children 9 years of age and older. Your child must be able to kayak and be phyically fit for these activities.

Scuba Camp is for 10 years of age and older.

Parents are welcome to join and participate in these camps. If you intend to do so, please fill out a seperate form for yourself.

Name of camper*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Age*

Please include campers height, weight and shoe size so we can have the appropriate equipment sizes.*

E-mail*

example@example.com

Phone Number*

Area CodePhone Number

Phone Number*

Parent / Guardian Name*

Authorization & Names of Adult(s) other than myself that can pickup my child in the event I'm not available: List full name and cell phone number. They will be required to show ID before we release your child.

Authorized Adult / Cell #

Items you must provide each day.*

Water shoes or sneakers. Absolutely no flip flops or crocks. Your child will be sent home if he or she does not have the appropriate foot wear which must be worn at all times for their protection. Below we offer water shoes for purchase that they can keep after camp in the payment area of this form.Eye protection. We suggest sunglasses with a floating lanyard.Snacks and 1 case of water is suggested for the week. Provide a soft cooler they can keep their water and snacks in.A waterproof dry bag is recommended if they have a cell phone, camera or keys which we have for sale in the payment area of this form.If attending Scuba Camp you must schedule an appointment to sign additional paperwork and purchase a mask, snorkel, fins and (wetsuit* if not available for rent). Rental gear is limited in youth sizes so please call after completing this form to reserve rental gear. Please do not buy any equipment before meeting with the Instructor to avoid un necessary expenses. Only certified scuba equipment will be allowed.If attending Kayak Fishing Camp, fishing rod, tackle box with leader line, hooks and appropriate tackle. Pair of scissors, dehooker, pliersHat, towel, sunscreen and change of clothing as they will get wet. You may want them to change before pickup.

Policies & Liability Form

By signing this waiver either electronically or in person, I acknowledge that I have read and agree to the policies set forth in this agreement. If for any reason other than stated in this agreement I must cancel my child's scheduled camp session, I agree to pay the camp fee in full. Any correspondences via email regarding camp information and scheduling can and will be used as receipt of services requested for billing purposes.

Cancellation Policy

Cancellation must be made within a minimum of 14 days in advance of the scheduled start date for the session your child is enrolled in. If you must cancel and can't give proper notice, we will try to reschedule your camp for another date. Full payment is due when signing up for any camp. The only way to sign up is via this form and will not accept walk in sign ups.

Waiver of Liability

I understand the purpose of signing this document is to exempt and release Cruise Fish Dive Inc., Reel 1 Up Fish& Dive Charters, Mark Garcy, the vessels Reel 1 Up, Spear 1 Up, Reel1In, kayaks and their owners, Collier County Parks and Recreation, Bonita and Naples YMCA, Lee County Parks and Recreation, Florida State Parks, dive instructors, employees, crew, contractors, agents, sponsors, volunteers, advertisers, it’s dive boats, whether chartered, leased, or owned and to hold these entities and individuals (THE "RELEASED PARTIES") harmless from any and all liabilities arising as a result of any acts or omissions on their part, including, but not limited to, active or passive negligence or negligence of any type. I recognize and acknowledge that there are certain risks of physical injury and property and I agree to assume the full risk of any injuries, including loss of life, personal injuries, property damages, and expenses, which I may sustain as a result of participating in any and all activities connected with the "Released Parties", or any services or activities associated with our companies. I further agree to waive and relinquish all claims to fully release, discharge, indemnify, hold harmless and defend the "Released Parties" from any and all claims resulting from injuries, including loss of life, personal injuries, property damages, and expenses, sustained by me or my minors and arising out of, connected with, or in any way associated with the activities or trips. The participant assumes all risks associated with participation at our facility, facilities camps are located or on any of our vessels, equipment or tours. The "Released Parties" assumes no liability for injury or damages arising from participation in our services. Due to the strenuous nature of some activities, the participant, or if the participant is a child, the child’s parent or guardian is encouraged to consult his or her physician concerning the participant’s level of fitness in relation to participation in any offered services.

I agree to all the above terms and conditions.*

Please choose which camp you will attend. *

Kayak Fishing Camp. Meet at the Cocohatchee River Marina or Imperial River Boat Launch. 9am-1:00pmScuba Camp. Meeting location will change daily based on what they will be doing.

Week attending. For multiple weeks, please submit a form for each week. *

In the event the week you choose is full or unavailable, please list your second and third choice when your child can attend.*

Camp Selection and other products.*

Kayak Camp$500.00

Embarq on a thrilling adventure with our Kayaking Camp! Young campers will master the art of kayaking while exploring the scenic Cocohatchee river and back bay waters. Delve into the fascinating ecosystem that thrives in these waters, gaining a deeper appreciation for the natural world.

Kayak Fishing Camp$600.00

At this camp, young adventurers will have the unique opportunity to master the art of fishing from a kayak while learning a range of fishing techniques.

Scuba Camp$699.00

Dive into an exciting underwater journey with our Scuba camp designed for individuals aged 10 and above. Your child will receive top-notch training to attain their PADI Junior Open Water Diver certification.

Standard Fishing Package $132.35

If attending the kayak fishing camp, your child will need fishing supplies to participate. We created a package to make it easy for you and so your child is prepared and has the best chance at catching a variety of fish. Orders must be made 3 weeks prior to start of camp to guarantee availability. If you have some of these items but not all, stop by and we can help assist in selecting the best options for this camp. 1. dehooking device 1. pliers 1. scissors 1. pack of 1/0 - 3/0 circle hooks 1. spool of leader material 30lb - 40lb 1. spinning rod/reel w/braided line (10-15lb) 1. tackle bag/box 1. pack of jigs 1. pack of #2 split shots 1. thunder bobber 1. spoon 1. swim bait 1. soft baits 1. Sabiki Hooks 1. Phone Dry Bag

Quantity

Complete Fishing Package$299.00

If attending the kayak fishing camp, your child will need fishing supplies to participate. We created a complete package to make it easy for you and so your child is prepared and has the best chance at catching a variety of fish. Orders must be made 3 weeks prior to start of camp to guarantee availability. If you have some of these items but not all, stop by and we can help assist in selecting the best options for this camp. 1. dehooking device 1. pliers 1. scissors 1. pack of 1/0 - 3/0 circle hooks 1. spool of leader material 30lb - 40lb 1. spinning rod/reel w/braided line (10-15lb) 1. tackle bag/box 1. pack of jigs 1. pack of #2 split shots 1. thunder bobber 1. spoon 1. swim bait 1. soft baits 1. Sabiki Hooks 1. Phone Dry Bag 1.Ugly Stik Rod & Abu Garcia Spinning Reel w/braided line

Registration Fee$35.00

Camp Registration Fee is Non Refundable.

Subtotal $0.00Tax $0.00Shipping $0.00Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Credit Card holders signature. I understand the above cancellation policy, liability waiver and agree to above charges.*

EMERGENCY TREATMENT CONSENT

I affirm I am the parent and/or legal guardian of*

child name

As the parent/guardian, I hereby authorize Cruise Fish Dive Inc., and/or its (agents, employees or assigns, to seek medical treatment for my child named below as a result of an accident or illness while under the supervision of Cruise Fish Dive by a qualified and licensed physician in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed.

I affirm I have read the Summer Cancellation Waiver form, signed it of my own free will, and understand the legal consequences of signing the document.

I have fully informed myself of the contents of this Emergency Treatment Consent Form by reading it before I signed it.

I authorize the treatment of:

Camper Name*

First NameLast Name

Parent Guardian*

First NameLast Name

Date*

MonthDayYear

Parent/Guardian Phone Number*

Phone Number*

Area CodePhone Number

Specific medical allergies, medicine being taken or other conditions physician should be aware of (if none, please write NONE):

List All:*

Special Medical of Physical Conditions:*

Restrictions on Activities:*

Medical Insurance Company*

Policy Number

(If applicable) I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information on this form with any Florida Excursions volunteers or professionals who need to know of medical conditions that may require special consideration in conducting camp activities.

I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. The participant has permission to engage in all activities described, except as specifically noted by me. If the participant is under the age of 18, a parent or guardian’s signature is required.

SUMMER CAMP SUPPLY LIST

Kayak Camp will meet at Cocohatchee River Park Marina by the small ship store & Imperial River Boat Launch. We will confirm the schedule prior to the start of camp the week before.

Bring plenty of water, sunscreen, a hat, towel, change of clothes, and snacks.If you have a favorite life jacket (we supply basic jackets).Water shoes are required.If they own a kayak and can paddle solo.

Kayak Fishing Camp will meet at Cocohatchee River Park Marina by the small ship store & Imperial River Boat Launch. We will confirm the schedule prior to the start of camp the week before.

Bring plenty of water, sunscreen, a hat, towel, change of clothes, and snacksIf you have a favorite life jacket (we supply basic jackets).Water shoes are required.If they own a kayak and can paddle solo.Fishing rod and gear.

Scuba Camp (Mon-Wed meet at Dive Shop/Pool, Thursday meet at Dive Shop/Beach and Friday meet at Dive Shop/Cocohatchee River Park Marina at for boat dives.

Bring plenty of water, sunscreen, a hat, towel, change of clothes, and snacks.Mask, fins, snorkel, boots and wet suit are not provided. These items can be purchased at our dive shop. Must be approved dive gear.It is required to come in a few weeks prior to the start of camp to try on gear and to allow time if something needs to be ordered.

At Cruise Fish Dive, we strive to make our summer camps safe, positive, and enjoyable for every camper. Therefore, our Camp Counselors work hard at creating an environment that allows this to happen. Along with the efforts of our staff, we need the campers to help us create a positive and fun camp by following simple, but effective rules. Below is our Behavior Agreement, parents and campers must read this over and to ensure everyone that understand what is expected of them and why you are signing it. This will help our staff help the campers have a great and memorable experience with Cruise Fish Dive.

Behavior Rules* Check each after reading and sign below.*

I will listen to the staff and follow their directions.I will respect other people's belonging by not touching/using anything without their permission.I will sit properly and attentively during any classroom training.I will not horseplay while in the classroom, pool, dive boats, or kayaks.I will respect other person’s space by keeping my hands and feet to myself.I will not hit or fight with other campers.I will be respectful to my fellow campers and use appropriate language.

Not abiding by these rules can result in suspension from the program. Hitting/fighting and bullying will be an immediate dismissal from the camp. All other incidents will be handled with a THREE Strike policy. If a camper violates the three strike policy, the parent or guardian will be called and the camper will be removed from camp. There will be no refunds if a camper is asked to leave camp.

Strike One: Verbal Warning and Parent/Guardian Notified at Pick Up.

Strike Two: Verbal Warning with a Time Out and Parent/Guardian Notified that a 3rd strike will result in the camper being removed with No Refund.

Strike Three: Parent/Guardian will be called and the camper will be removed from camp with No Refund.

I agree to Cruise Fish Dive Tolerance Policy and understand that if the camper is removed there will be no refund.

Parent Name*

Camper Name*

I agree to and understand the above Behavior Rules (Camper Signature)*

I agree to and understand the above Behavior Rules (Parent Signature)*

Registration fee and payment made when submitting this form.

Summer Camp Registration Form and Waiver