In consideration of the participation in the Program(s) above, which includes Use of Camp Bearfoot Premises or Participation in Off-Premises Activities as defined below, by my Minor Participant, I hereby agree to all of the terms and conditions in this Kid's Camp Registration, including specifically the ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, and INDEMNIFICATION provisions.
I understand that there are inherent risks of injury in the use of Camp Bearfoot's premises while participating in Camp Bearfoot's Program(s), including but not limited to its indoor and outdoor areas, sidewalks, and parking lots ("Use of Camp Bearfoot Premises"). I also understand that there are risks of injury in participation in the Program(s) that take place outside or off Camp Bearfoot's premises, including but not limited to field trips ("Participation in Off-Premises Activities") (collectively,"Risks").
I understand that such Risks include but are not limited to slip and falls, trips, collisions, overexertion, loss or theft of property (including from lockers), equipment failure or malfunction, drowning, or other accidents or incidents that may result in harm, loss, disability, death or other injury or damage to my Minor Participant. I understand that such injuries may include, but are not limited to, minor or major personal, physical, bodily, emotional, mental, economic, property or other types of injuries or damages, including but not limited to scrapes, bruises, sprains, torn or damaged muscles or ligaments, broken bones, burns, respiratory or auditory problems, concussion, strokes, heart attacks or stress, lost wages, lost earning capacity, lost or stolen property, pain and suffering, disfigurement, paralysis, brain damage, or death ("lnjury"or"lnjuries").
I understand that such Injuries may be caused, in whole or in part, by the negligence of Camp Bearfoot (which includes its subsidiaries and employees), me, my Minor Participant, other participants in the Program, and/or other members or guests.
I fully understand and appreciate, knowingly and voluntarily accept, specifically assume responsibility for, and freely choose to allow my Minor Participant to participate in the Program(s) which include the Use of Camp Bearfoot Premises or Participation in Off-Premises Activities in spite of, the Risks of Injury set forth above.
Participants, parents, guardians, heirs, next of kin, personal representatives, assigns and estate, I hereby voluntarily and forever release and discharge Camp Bearfoot from, covenant and agree not to sue Camp Bearfoot for, and waive any and all present and future claims, demands, actions, causes of action, damages, losses or any other alleged liabilities or obligations, whether known or unknown ("Claims"), for any Injuries (which includes personal injuries and property damage) to me or my Minor Participant sustained in the Use of Camp Bearfoot Premises or Participation in Off-Premises Activities which arise out of, result from or are caused by, the negligence of Camp Bearfoot ("Waived Claims").
I agree to defend, indemnify, protect and hold and save harmless Camp Bearfoot against any and all Waived Claims, including but not limited to those arising out of, resulting from or caused even in part by Camp Bearfoot's negligence, as well as any other Claims arising out of, resulting from, or caused by the Use of Camp Bearfoot Premises or Participation in Off-Premises Activities, by me or my Minor Participant.
Bearfoot Companies LLC. and Camp Bearfoot LLC., its affiliates, subsidiaries, officers, directors, employees, independent contractors, representatives, volunteers, and successors or assigns, all of whom shall be collectively referred to and embraced herein as "Camp Bearfoot”, will allow only a parent, legal guardian or authorized adult to admit Minor Participant into the care of Camp Bearfoot by signing Minor Participant into the care of Camp Bearfoot. I will not leave the Minor Participant at the Program unless a Camp Bearfoot staff member is there to receive and supervise Minor Participant. Camp Bearfoot will not at any time accept a sick child for care. In the event my child gets sick and needs to leave Camp Bearfoot, I agree to pick up my child immediately
Youth Birthday (MM/DD/YY):
Youth Birthday (MM/DD/YY):
Youth Birthday (MM/DD/YY):
I understand that the Minor Participant may only be signed out of the care of Camp Bearfoot to Minor Participant's parent or legal guardian, to a person that has been identified as an emergency contact or other authorized pickup below, or to a person previously authorized in writing to pick by the Minor Participant's parent or legal guardian. All such individuals are responsible for compliance with Camp Bearfoot's policies and procedures. Government- issued picture identification will be required every time the Minor Participant is to be released from Camp Bearfoot. Any person authorized to pick up the Minor Participant must be listed below or have obtained prior written permission from the undersigned:
The undersigned hereby gives permission for the Minor Participant to participate in a Program involving activities such as, but not limited to Karate, gym games, sport specific games, Dodgeball, self select stations, viewing pre-identified age appropriate videos, yoga, and stretches and exercises planned by NASM certified trainers. If I foresee any issues with the Minor Participant participating in any of the camp activities it is my responsibility to notify the camp supervisor. At the time of registration I have concerns with the following activities noted below [If none, please state NONE]:
List Activity concerns below:
I agree that I will inform Camp Bearfoot within 24 hours or the next business day after the Minor Participant or any member of the immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life-threatening diseases which must be reported immediately. I agree that in the event the Minor Participant is involved in an accident that requires medical attention, the undersigned will be responsible for making all decisions related to all medical and survival procedures for the Minor Participant, including but not limited to the decisions about medical care, the administration of drugs and the performance of any and all life sustaining procedures. The undersigned further agrees to make any and all arrangements for the Minor Participant's transportation and admittance to any hospital, health center or medical clinic in the event of any emergency situation involving the Minor Participant. In the event that parent(s) or emergency contacts are unavailable and it should become necessary, I authorize Camp Bearfoot to make decisions regarding any and all medical and survival procedures for the Minor Participant. The undersigned agrees that Camp Bearfoot, its staff members, volunteers and chaperones will not be held liable for any accident or losses, however caused.
Name of Physician:
Address of Physician:
Phone Number of Physician:
I agree that Camp Bearfoot is not liable for the Minor Participant contracting any viruses while participating in the Program.
Please select one of the following:
I certify that the Minor Participant has received all necessary immunizations from a medical professional and the immunizations are current. If Minor Participant is homeschooled or not yet enrolled in school, I will provide Camp Bearfoot with a copy of the immunization records.The Minor Participant has NOT received all necessary immunizations due to the immunization being detrimental to the Minor Participant's health, or due to personal or religious beliefs.
If the copy of the participants’ immunization records are kept at the participants school, Please provide the info below:
School Phone Number:
Last Grade Attended:
Please check one of the following:
I DO NOT wish Camp Bearfoot to administer any medication, either prescription or over-the-counter, to the Minor Participant during the Program.I DO wish a designated Camp Bearfoot staff member to administer medication, either prescription or over-the-counter, to the Minor Participant during the Program. I understand that Camp Bearfoot requires the following items and that no medications will be administered by Camp Bearfoot until the following have been properly provided:
The following must be provided for Camp Bearfoot to administer medication to a participant:
Physician's Letter. The undersigned must have a physician provide a signed letter to Camp Bearfoot addressing the following for any type of medication to be administered: (i) name of medication, (ii) purpose for medication, (iii) dosage and frequency, (iii) duration of medication, (iv) method of administration, and (v) any additional instructions, adverse reactions, precautions or other relevant information. This letter must include the name and birth date of the Participant as well as the name, telephone and fax number of the physician. I understand that the medication will be administered according to the direction of this physician and that any changes in medication require an updated letter from a physician before the medication will be administered by Camp Bearfoot; and Medication Container.
Any prescription medication to be administered during the Program must be provided in a container with a pharmacy label clearly stating the Participant's name, medication dosage and frequency, the date of the prescription and the recommending physician's name.
Any over-the-counter medications to be administered during the Program must be provided in its original container and have the Participant's name, frequency and dosage clearly marked on the container. Any medication must be delivered only to a Program director by a parent or legal guardian of the Participant. I understand that any changes in any medication require a new container that meets the requirements listed in this section.
Camp Bearfoot requires that a parent, legal guardian, or other authorized pick-up call Camp Bearfoot if he or she knows or suspects that he or she will be late in picking up the Minor Participant. A Late Pick- Up Fee will be charged in the amount of $1.00 per minute that a parent, legal guardian, or other authorized pick-up is late. This Late Pick-Up Fee is payable upon the parent, legal guardian or other authorized pick-up's arrival or it will be due the following day If the Minor Participant is left for 2 hours past the Program pick up time without a parent or legal guardian notifying the staff and the staff is unable to locate an emergency contact, the police will be notified. If the Minor Participant is left for 1 hour or more past the Program pick up time on 2 occasions without notifying the Camp Bearfoot Activity Center, Minor Participant will no longer be allowed to participate in the Program. Upon such event, no fees will be refunded by Camp Bearfoot.
Camp Bearfoot will serve snacks and provide a time for meals to Minor Participant in accordance with the following schedule: (1) If Minor Participant has been in Camp Bearfoot's care for more than 2 hours, but less than 4 hours, Camp Bearfoot will serve 1 snack; (2) If Minor Participant has been in Camp Bearfoot's care for 4 to 6 hours, Camp Bearfoot will serve 1 snack and provide time for 1 meal; (3) If Minor Participant has been in Camp Bearfoot's care for 7 to 10 hours, Camp Bearfoot will serve 2 snacks and provide time for 1 meal All snacks provided by Camp Bearfoot will be within the guidelines of the Food Guide Pyramid, as developed and recommended by the U.S. Dept, of Agriculture. Any child with special dietary needs will be provided with snacks by Camp Bearfoot in accordance with such child's needs and with the instructions of the child's parent or legal guardian. Camp Bearfoot will provide a time for a meal or meals according to the above schedule for Minor Participant. However, Minor Participant's parent or legal guardian is responsible for providing the meal or meals for Minor Participant while he or she is in Camp Bearfoot care. No refrigeration will be provided for meals; please include only appropriate non-perishable food items. Each parent or legal guardian shall be responsible for ensuring that any such meals meet the dietary guidelines for Americans established by the U.S. Dept, of Agriculture. Please ensure that each meal is labeled with your child's name and date. Camp Bearfoot is not responsible for such meals' nutritional value or for meeting the Minor Participant's daily food needs.
Specific Food Allergies:
The undersigned hereby irrevocably consents to and grants Camp Bearfoot the exclusive and unlimited right to use and reproduce any and all photographs, slides, moving pictures, audio and visual recordings testimonial accounts taken by Camp Bearfoot that contain my Minor Participant's name, image, voice, likeness or account, for any lawful purpose whatsoever and using any means available including but not limited to any of Camp Bearfoot's records, corporate public relations or marketing communication material, videos or online material, social media campaigns, either with or without the Participant's name or photo accompanying such quotation. I waive the right to inspect, approve or edit any such use or reproduction, and Camp Bearfoot may make any and all changes, modifications, rearrangements, additions or deletions in its use reproductions without any approval
Please select one of the following below:
I DO allow Camp Bearfoot to use any form of mediaI DO NOT want my child in any use of media
I hereby certify that I have read and understand this entire Agreement and agree to and accept the terms and conditions of this entire application. Minor Participant will receive the privilege of participating in the Program, and I agree that he or she will abide by all rules and regulations of Camp Bearfoot, which are subject to change and which in the opinion of Camp Bearfoot management, are deemed necessary and reasonable for the best interest of members, participants in its Programs and Camp Bearfoot.
Please sign below if you agree to the above terms and conditions to the Camp Bearfoot Camp Registration Form
Parent/Guardian Phone Number:
Payment is accepted the first day of each week attended. Cash, Check, Credit Card are all accepted forms of payment.
If you would like for your child to attend individual days, select the week and provide dates in the box below. If there is any questions or comments, add in box below.
If you experience any difficulties with registration, please email us at [email protected]