Authorization of Payment
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 prior to appropriate payment date or cancellation date to discontinue my credit card/bank draft.
• Cancellation prior to each camp week’s Draft Date will result in full refund.
• Cancellation between each camp week’s Draft Date and Last Date to cancel will result in a partial refund minus a $25 dollar cancellation fee.
• Cancellations after the Last Day to cancel will receive no refund.
Authorization of Check-In/Check-out Procedure
I understand that the individuals listed under my child(s) authorized pick-ups and emergency contacts must provide a form of legal identification to pick-up my child(s).
Only primary parent/guardian will be allowed to change or edit the list of authorized pick-ups and/or emergency contacts and these changes must be made with the Registrar, Coordinator and/or Director. Should an emergency occur and the primary parent/guardian cannot be reached, it will be at the discretion of the Coordinator and/or Director to allow pick-up of Camper(s) by those not listed on the Camper Information Form.
If my child is age 12, or 13 and registered for Tween Camp, I give them permission to sign themselves in during camp check-in times and sign themselves out during camp check-out times. If my child is age 14, 15, 16, or 17 and registered for Summer Teen Volunteer Program (STVP) I give them permission to sign themselves in and out of the camp program.
Authorization of Camper Expectations
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 camper information form and follow up with the camp staff to ensure those accommodations are met.
I have reviewed the program and camp activities, and deem my child able to participate without restrictions. I have made the Camp Director and/or Coordinator aware of any specific needs my child(ren) may have.
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.
Should my camper need to take any medication during Camp hours, it is my responsibility to complete a medication form prior to the first day of Camp. Only the Director, Coordinator and/or Inclusion Counselors will be permitted to distribute such medication. I hereby authorize the YMCA of Pierce & Kitsap Counties to administer medication upon request.
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. Removal of programming is at the discretion of the Camp Director and/or Camp Coordinator and may or may not be with any prior notice. Immediate removal from camp include, but are not limited to the following:
• Physical violence to one’s self or others
• Destruction of property
• Bullying - Repeated unwanted or aggressive behavior
• Inappropriate behavior (i.e. inappropriate touching, lewd comments, racial slurs, etc,)
• Verbal threats of harm
Authorization of Emergency Care
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, but not limited to, 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.
Authorization of Photographs and Media
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. It is my personal responsibility to notify the Director should I request that my child(s) photo not be taken and used.
Authorization of Additional YMCA Policies
I understand that all policies and procedures listed above are upheld by each branch or site. Additionally, I understand that certain sites might have further specific procedures for that specific location. I recognize the need for each procedure and myself and my child(ren) will aim to uphold each.
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, and release 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 that I am waiving all claims I may have against the YMCA arising out of the ordinary negligent acts by the YMCA, and I agree that I will not bring a lawsuit against the YMCA arising out of its ordinary negligence. If any portion of this Release is held invalid, the remainder shall continue to be enforceable.