Camper Agreement
I will obey all directions and rules given by the Henry’s Place staff. I understand that attending camp is a privilege and that I could be sent home or not allowed to participate in certain camp activities if I fail to follow rules.
Parent Agreement
PERMISSION STATEMENT:
Camper Registering has my permission to participate in 2018 Henry’s Place Summer Camp Activities during the following dates:
Henry’s Place is not staffed, trained or organized to provide services to campers with significant clinical medical, behavioral, or mental health concerns. Likewise Henry’s Place may not be able to accommodate significant diet restrictions or food allergies. Contact the Camp Director at (229) 415-2999 to determine eligibility if your camper has any of these needs.
MEDICAL RELEASE:
In the event of a medical emergency, I hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for the registered camper named on this form. I also agree to pay for any fees incurred, and I understand that Henry’s Place and its staff will not be held responsible or liable for any related expenses.
CONSENT TO USE PHOTOS AND VIDEOS:
I hereby grant to Henry’s Place and its agents (volunteer or paid) permission to store and/or use my above named child’s likeness in photograph(s)or video(s) in any and all of its publications and in any and all other media, in perpetuity, for the purpose of documenting and promoting Henry’s Place activities and mission . I will make no monetary or other claim against Henry’s Place for the use of the photograph(s)/video(s).
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT:
With regard to the registered minor camper named on this form, I fully understand that camp activities include physical exertion, sports, equestrian activities, exposure to domesticated animals, hiking, transportation in automobiles, use of archery equipment and tools, swimming and various other activities that may involve risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my minor camper’s own actions, or inactions, those of others participating in the activity, the conditions in which the activity takes place, or the negligence of the Releasees named below, and that there may be other risks either not known to me or not readily foreseeable at this time, and I fully accept and assume all such risks and all responsibility for losses, cost, and damages my minor camper may incur as a result of his/her participation in the activity.
Additionally, I am aware of the inherent risks, both natural and man-made, associated with an outdoor and/or camp setting, independent of organized events or volunteer activity. On behalf of my minor camper, I further fully accept and assume all such risks and all responsibility for losses, cost, and damages my minor camper may incur during Henry’s Place Camp activities.
I, the minor camper’s parent and/or legal guardian, understand the nature of the above referenced activities and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS Henry’s Place, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, HP Lodge, LLC, and Camp Lutherwood, owners and lessors of premises on which the activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses or damages on the minor’s account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasee may incur as the result of any such claim.
I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY
AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
