Camp Forever August 24-26, 2018

Transcription

1 Camp Forever August 24-26, 2018 Registration is open for all eligible families on July 1, Completed registration packets can be submitted as follows: 1) By mail, along with a check made out to KBYH or with credit card information completed below, sent to KBYH, 1321 Stine Rd. Bakersfield, CA ) By , by completing this registration packet, including credit card information below, and sending it to carrie@kernbridges.com For your registration to be considered complete, the following must be included in full: 1) This completed 4-page registration form and a Child/Youth Questionnaire (attached) for each child/youth attendee. 2) Full payment of registration fees: $40 per person. 3) Completion of the CCRC waivers for each camper (included below) 4) Your family meets the eligibility requirements: * The family has adopted (or completed adoptive placement) through the Kern County foster care system and the adoptee is still a minor * All children attending are ages 5-17 * Families are willing and able to share bunk bed accommodations with other families * All campers must live in the adoptive home (exceptions will be considered, contact Carrie prior to sending in your registration ) * Participants are able to navigate a campground setting Payment Information I am paying by: Check* (check #: ) Credit Card (complete below) Visa or Mastercard #: 3-digit security code (from the back of the card): _ Expiration date: / Name on card (please print) Signature *If we receive notification from our bank that your personal check is being returned for non-sufficient funds, you will need to re-submit a money order or cashier s check plus a non-refundable $25 processing fee AND your place in line will be forfeited. 1

2 How did you learn about Camp Forever? Our family would like to share a cabin with: (we will do our best to accommodate requests) If there is anything you d like us to keep in mind when planning which families will be sharing cabins, please indicate it here: Camper Information: Adult camper #1 name: Shirt size: Special issues/disabilities, if any (dietary, mobility, etc.): Primary language: Ethnicity: Home phone: Cell phone: Mailing Address: Street City, State, Zip Adult camper #2 name (if applicable): Shirt size: Relationship to Adult camper #1: Special issues/disabilities, if any (dietary, mobility, etc.): Primary language: Ethnicity: Child/Youth Campers* (5-17 years old): *A separate Child/Youth Questionnaire must be enclosed for each child/youth listed. Please be sure to indicate if shirt size is youth or adult size: 2

3 *If more than 6 children, please contact Carrie: Disclaimers I/We, the undersigned, understand and agree to the following: * Should I/we successfully register for camp, space will be reserved for my/our family. All registered family members will show up to camp on Friday and will be committed to staying at camp for the entire two nights/three days. * I/we need to advise Camp Forever/KBYH as soon as possible if for any reason any or all of us cannot attend camp. Families on the waiting list will need to be advised of open slots. Giving as much advance notice as possible is also critical due to families sharing cabins. * I/we need to advise Camp Forever/KBYH if the number of campers in my/our party changes. Camp Forever/KBYH may not be able to accommodate additional campers in my/our families, other than those originally registered. * Camp Forever has simple rules, which are designed to ensure that every camper has a safe and happy experience. Campers who interfere with other camper s peaceful enjoyment of the experience, who fail to adhere to the rules, or who create unsafe situations for children or adults, may be asked to leave camp and may not be invited to future camps. -Camp Forever rules: ~All adults will attend all scheduled workshop sessions. ~All children and youth will attend all sessions and activities ~My/our children must be supervised at all times by an adult. Other than when engaged in a specific activity supervised by camp staff, my/our children s conduct and safety are my/our responsibility. ~No pets, fireworks, firearms, weapons or alcoholic beverages are allowed. ~No smoking except by adults only in the designated areas ~Quiet hours are from 10:00PM to 7:00AM ~Food and drink (except water) is discouraged in sleeping rooms. If you bring food/drinks, please keep them sealed/bagged and be sure to throw out all trash. ~Lights need to be turned off and doors closed when exiting sleeping rooms to conserve energy. ~Trash should be picked up so that camp is as clean as or cleaner than when we arrived. ~Valuables should be left at home or locked up appropriately. Camp Forever/KBYH/Kern County DHS/CCRC cannot be responsible for lost or stolen items. ~Photography/videoing of anyone other than your family is highly discouraged (unless you have asked for consent of the other party(s)). ~Any and all medications must be kept secure at all times. Medications must be kept locked in your vehicle or can be kept at the nurse s station upon check-in. * I/we, the undersigned, agree to abide by all rules/policies established for Camp Forever. Further, I/we understand that failure to comply with rules will jeopardize our ability to remain at Camp Forever and to attend in subsequent years. Signed: Date: Signed: Date: 3

4 Camp Forever Child/Youth Questionnaire (Print and complete one Questionnaire for each child/youth attendee) 1) Family Name: 2) Name of child/youth: DOB: 3) Child/youth s primary language: Ethnicity: 4) If your child has developmental disabilities and functions at a developmental age that is different from his or her chronological age, please indicate his/her developmental age: 5) Attending children must live in your home. It is also helpful for Camp Forever staff to understand the circumstances of how the children have come to reside with you. Please indicate how the child/youth came to live in your home: Birth Adopted Foster Other: 6) Using the following check list, please indicate if any of these behaviors or physical/developmental concerns apply to your child/youth (check all that apply): Developmental Delays Developmental Disabilities Attention/Hyperactive Problems with Peers Mobility issues Vision or Hearing issues Medical concerns Lying Tantrums Stealing Running away Withdrawal/depression Sexual acting out Hitting/kicking/aggression Non-compliant/oppositional Incontinence Substance abuse/smoking Swearing Food issues (include special dietary needs below) If any of the above are checked, please explain further: 7) The following is a sample of some of the activities we have planned. If you feel strongly that your child either can t participate in a certain activity or would need some kind of adaptation to the activity, please describe below. *Hiking Swimming pool *High ropes course *Go-Karts *Field games *Frisbee golf *Climbing tower *Archery Please explain any concerns: 8) Special issues, if any (dietary, mobility, etc.): 9) Parents bringing foster children to camp: Please check NOW with their social workers regarding any special permission needed for them to attend this camp. Please advise Camp Forever/KBYH as soon as possible if they will be unable to attend. 4

5 Canyon Creek Complex Waiver of Liability/Release of Claims/Consent to Use of Images Adults Participating in Camp Activities Event: Camp Forever- Canyon Creek Camp Weekend (the Event ) Dates of Event: August 24-26, 2018 Participant's Name: (hereafter Participant ) Phone ( ) Address The undersigned Participant acknowledges that while at Canyon Creek Complex ( Camp ) and participating in the Event, Participant may or will be participating in sporting and recreational activities on the grounds of the Camp including, but not limited to: ropes course, climbing walls, trapeze leap, football, basketball, soccer, hockey, baseball, golf, volleyball, tennis, dodgeball, archery, swimming and other water sports and other sports and activities (collectively, Camp Activities ). Participant understands that many of these activities may involve a high degree of risk of injury to Participant. Participant has been advised that Participant should be evaluated by his/her physician p rior to participating in any Camp Activities. Participant further acknowledges and agrees that Canyon Creek Sports Camp, Canyon Creek Properties, LLC, Canyon Creek Holdings, LLC, the individual organizers and directors of the Event, and all owners, officers, directors, members, partners, employees, agents, affiliates and representatives of the foregoing (collectively, Personnel ) will not be responsible or liable for any injuries, claims, liabilities or damages, of any kind which are sustained, suffered or incurred by Participant as a result of (a) his/her or their participation in Camp Activities or in the Event or attendance at Camp and (b) the negligence of any Personnel. In consideration of Participant s voluntary participation in Camp Activities and in the Event, to the extent permitted by law, the undersigned Participant, on behalf of him/herself and for his/her heirs, executors, guardians, legal representatives, administrators and assigns, hereby RELEASES, WAIVES, DISCHARGES AND HOLDS HARMLESS all Personnel from and against any and all injury, disability or death, loss or damage to person or property, and all claims, damages, liabilities, losses, costs, expenses, actions and causes of action (collectively, Claims ) which may hereafter arise or be suffered or incurred by Participant or by Participant s estate as a result of any of the foregoing mentioned in (a) and (b) above. Participant acknowledges and agrees that Participant will be solely liable for any and all injuries or damages of any kind or nature sustained, suffered or incurred by any other camper or other person as a result of the Participant s participation in Camp Activities and/or the Participant s conduct or actions at Camp, whether intentional or otherwise, or, to the extent permitted by law, whether resulting from the negligence or any other acts of any Personnel. Participant agrees to and shall indemnify, defend, reimburse and hold harmless all Personnel from and against any and all Claims, (including reasonable attorney s fees and costs), suffered or incurred by Personnel or others as a result or arising out of or in connection with Participant s participation in Camp Activities and/or Participant s conduct or actions at Camp. Participant acknowledges that photography and video or digital film may be shot at Camp during the Event. Participant consents to and authorizes the use of Participant s name and likeness/performance in whole or in part on film, videotape, in digital images or in any other media (collectively, "Images"). Participant agrees that Canyon Creek Sports Camp, [ADD IF APPLICABLE and the Harold Robinson Foundation] and [its] [their respective] parent and affiliated companies may use any Images for any private, promotional or commercial use (including, without limitation, on the Canyon Creek Sports Camp, Harold Robinson Foundation websites or in any promotional materials or advertising media) without compensation or notice to Participant. Participant also authorizes the use of Participant s name, likeness and Images by any news organization (including television, radio, internet or newspaper) that may report on or produce a story or article on the Event or the Camp. Participant acknowledges that he/she has read the foregoing paragraphs, has been informed of the risks faced by the Participant as a result of Participant s participation in Camp Activities and in the Event and has voluntarily signed this Waiver of Liability / Release of Claims with full knowledge of the legal consequences of doing so. Signature of Participant Date:,

6 CANYON CREEK COMPLEX WAIVER OF LIABILITY/ RELEASE OF CLAIMS/CONSENT TO USE OF IMAGES-CHILD Event: Camp Forever-Canyon Creek Camp Weekend (the Event ) Dates of Event: August 24-26, 2018 Camper s/child Participant's Name(s): (hereafter Camper ) The undersigned warrants and represents that he/she is a parent or legal guardian of Camper and that the undersigned possesses the authority to execute this Waiver of Liability/Release of Claims on behalf of Camper. The undersigned acknowledges that while at Canyon Creek Complex ("Camp") and participating in the Event, the Camper may or will be participating in sporting and recreational activities including without limitation, ropes courses, climbing walls, trapeze leap, football, basketball, soccer, hockey, baseball, golf, volleyball, tennis, dodgeball, archery, swimming and other water sports and other sports and activities (collectively, Camp Activities ). I understand that many of these activities may involve a high degree of risk of injury to the Camper. The undersigned acknowledges that he/she has been advised that the Camper should be evaluated by his/her physician prior to participating in Camp Activities. The undersigned further acknowledges and agrees that Canyon Creek Sports Camp, Canyon Creek Properties, LLC and Canyon Creek Holdings, LLC and the individual organizers and directors of the Event and all owners, officers, directors, members, partners, employees, agents, affiliates and representatives of the foregoing (collectively, "Personnel") will not be responsible or liable for any injuries, claims, liabilities or damages of any kind which are sustained, suffered or incurred by the Camper as a result of (a) his/her or their participation in Camp Activities or in the Event or attendance at Camp and (b) the negligence of any Personnel. In consideration of the Camper's voluntary participation in Camp Activities and in the Event, to the extent permitted by law, the undersigned, on behalf of the Camper and for the Camper's heirs, executors, distributees, guardians, legal representatives, administrators and assigns, hereby RELEASES, WAIVES, DISCHARGES AND HOLDS HARMLESS all Personnel from and against any and all injury, disability of death, loss or damage to person or property, and all claims, damages, liabilities, losses, costs, expenses, actions and causes of action (collectively, Claims ) which may hereafter arise or be suffered or incurred by the undersigned, Camper or Camper's estate as a result of any of the foregoing mentioned in (a) and (b) above. The undersigned acknowledges and agrees that the undersigned will be solely liable for any and all injuries or damages of any kind or nature, sustained, suffered or incurred by any other camper or other person as a result of Camper's participation in Camp Activities and/or the Camper's conduct or actions at Camp, whether intentional or otherwise, or, to the extent permitted by law, whether resulting from the negligence or other acts of any Personnel. The undersigned agrees to and shall indemnify, defend, reimburse and hold harmless all Personnel from and against any and all Claims (including reasonable attorney's fees and costs) suffered or incurred by Personnel or others as a result or arising out of or in connection with Camper's participation in Camp Activities and/or Camper's conduct or actions at Camp. The undersigned acknowledges that he/she has read the foregoing paragraphs, has been informed of the risks faced by the Camper as a result of Camper's participation in Camp Activities and in the Event and has voluntarily signed this Waiver of Liability/Release of Claims with full knowledge of the legal consequences of doing so. The undersigned has executed an Authorization for Agent to Consent to Medical Treatment of a Minor which would permit the Camp Director, Camp Nurse or other Personnel to consent to necessary medical treatment for the Camper as a result of any injury sustained during the Camper's participation in Camp Activities, participation in the Event or attendance at the Camp. The undersigned acknowledges that photography and video or digital film may be shot at Camp during the Event. The undersigned consents to and authorizes the use of Camper s name and likeness/performance in whole or in part on film, videotape, in digital images or in any other media (collectively, "Images"). The undersigned agrees that Canyon Creek Sports Camp, [ADD IF APPLICABLE The Harold Robinson Foundation] and [its] [their respective] parent and affiliated companies may use any Images for any private, promotional or commercial use (including, without 6

7 limitation, on the Canyon Creek Sports Camp [and, Harold Robinson Foundation] websites or in any promotional materials or advertising media) without compensation or notice to Camper or the undersigned. The undersigned also authorizes the use of Camper s name, likeness and Images by any news organization (including television, radio, internet or newspaper) that may report on or produce a story or article on the Event or the Camp. Signature of Parent/Guardian Date:, 2018 Printed Name of Parent/Guardian 7