Please complete 1 form for each camper you have registered for camp in 2019.
(Must provide Court Documentation to Withhold Child from Parent)
Medical authorization form must be filled out on site. Must be turned in with medication (in the original prescription container)
I authorize the YMCA of Pierce and Kitsap Counties (“the Y”) to charge my credit card/bank draft for camp payment.
I understand the fees are drafted the Friday (Wednesday for school-based-locations) a week before, the week of camp your child attends.
I understand payment expectations and have chosen my payment method. I agree to abide by all policies in place, including that any changes must be in writing direct to the YMCA branch my child is attending. I understand failure to uphold my payment arrangements will result in cancellation of registration from the program.
I understand that if payment is not able to be collected upon weekly draft, a $30 non-sufficient funds/processing fee will automatically be added to my account.
I understand I must provide written notice of cancellation, change, or update to my child’s enrollment at least two weeks prior to the date of credit card/bank draft to discontinue the charge.
I have reviewed the program and camp activities, and deem my child able to participate without restrictions.
I am aware and approve of my child having an opportunity to participate in program activities which may involve a degree of risk and hereby release the Y from any and all responsibility and liability of any nature resulting from my child’s participation in YMCA activities and transportation as required.
I understand the Y does not provide one-on-one care for campers, but will work with me to provide reasonable accommodations to make my child successful in camp. If my child needs special accommodations, I understand it is my responsibility to make a note on the registration form and follow up with the camp director to ensure those accommodations are met.
I authorize assistance be given to my child, including staff administration of hand sanitizer. I understand sunscreen must be approved by me, and my child is responsible for applying it to him/herself while at camp.
I recognize my child is expected to follow all safety instructions, remain in areas designated by staff, and refrain from behavior harmful to oneself or others. I understand that failure to adhere to program and behavior policies could be cause for my child’s dismissal without refund of program fees.
In the event my child is injured, I give the Y’s first-aid/CPR-certified staff authority to provide basic first-aid and/or CPR as the situation requires, including splinter removal, as necessary and/or if my child becomes seriously ill or injured and I cannot be reached.
I authorize any emergency transportation, hospitalization, x-ray, medical, dental, and/or emergency surgical treatment for my child advisable by the circumstances by any member of the medical staff of the medical facility.
I understand it is my responsibility to provide my own accident and health insurance while participating in all YMCA activities, and that the Y does not provide any health or accident coverage for its participants.
I grant permission for photographs/videos which include my child in YMCA records, program projects, marketing, and public relations to be used in media releases and benefit the center to be taken.
If my child is age 11, 12, or 13 and registered for Tween Camp, I give them permission to sign themselves in between 8:30 and 9am, and sign themselves out between 3:30 and 4pm. If my child is age 14, 15, 16, or 17 and registered for Counselor-in-Training and Fieldwork, I give them permission to sign themselves in and out of the camp program.
I have included all information as requested above, and if there is a secondary responsible party, it is my responsibility to have this form duplicated and submitted to that party for their acceptance of payment policies and procedures.
With my signature below, I agree to the policies outlined in this form and the Parent Hand Guide information, including cancellations (due to unpaid tuition and behavior) and refund policies.
I am aware that participation in YMCA programs and use of YMCA facilities may involve certain hazards associated with equipment, physical exertion, games, sports, and other programs/activities offered by the YMCA. In consideration of, and as part payment for, the right to use YMCA facilities and participate in YMCA programs, I hold harmless, waive, andrelease the YMCA (“YMCA” includes its employees, volunteers, directors, officers, and agents) for damages of any type, including permanent physical injuries or death, arising out of the ordinary negligence of the YMCA and also for damages of any type arising out of my own negligence, in whole or in part.
I assume all risk of injuries and damages associated with my participation in YMCA programs and the use of YMCA facilities including, but not limited to, falls, slips (whether occurring while in the building, offsite as a part of a program, or anywhere else on the YMCA facilities or property, including adjacent sidewalks, access, and parking areas), contact with other participants, sudden and unforeseen malfunctioning of any equipment, instruction, training, supervision, massage, therapy, classes, or dietary recommendations, the effects of the weather and/or temperature indoor or outdoor, and all other such risks being known and appreciated by me.
This release includes foregoing any claim I may have for ordinary negligence arising out of my children’s use of YMCA facilities or participation in YMCA programs. I understand that it is my responsibility to obtain a physician’s release statement if my child has any physical or mental condition that may impair his or her ability to engage in any of the YMCA’s programs or activities.
I fully understand and agree I am waiving all claims I may have against the YMCA arising out of the ordinary negligent acts by the YMCA, and I agree I will not bring a lawsuit against the YMCA arising out of its ordinary negligence. If any portion of this Release is held invalid, I agree the remainder shall continue to be enforceable.