Summer Camp Registration

Cash, Check or PayPal accepted. 10% discount for Cash. Make checks payable to: The Ohmapi Nature Project. PayPal to DawnRobinette@mac.com. Payment due within 5 days prior to start of camp. There are no refunds if cancellation is less than 5 days before the first day of class. No refunds will be given in the middle of a session.

Please pack a lunch, snack, water, sunscreen and anything else your child may need each day. We do not allow the use of devices with screens or devices during class. Devices may be brought to class but must be powered off and kept in your child’s backpack during class time.

Camper's Name

First Name

Last Name

Camper's Age

Gender

Date of birth

Grade

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Parent/guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Enter the best number to reach you in case of emergency

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Safety Rules Agreement: Parents, Please review the following rules with your child and sign below. 1. Our number one rule at summer camp is to treat one another with love, kindness and respect. 2. Campers will stay with the instructor and/or group at all times. 3. Campers will refrain from wandering off. I have read and fully understand the terms and conditions of enrollment. I have discussed the above rules with my child. My child understands the safety rules listed above.

Please Sign Below

ALLERGIES: Please list any allergies your child has

List any other medical conditions for staff information:

List any food restrictions for staff information:

Does your child require an EPI pen?

If yes, please describe why your child requires an Epi pen:

MEDICATIONS: Does your child require medication administered during Camp ___Yes ___No If your child is taking medication, we ask that you keep medication in original package, write camper’s name on container and provide a note for medication administered during camp.

Is your child able to participate in all camp activities

If no, describe any restrictions

EMERGENCY TREATMENT RELEASE Dates during which release is granted – FROM: June 20, 2022 to August 12, 2022 TO WHOM IT MAY CONCERN: As a parent and/or guardian of the minor named below, I herewith authorize the treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. In case of emergency, The Ohmapi Nature Project has my permission to seek medical treatment for my child

Please sign and date below.

Please provide Doctors Name and Phone Number

PARENT AUTHORIZATION I certify that the above Health History and Medical Release Form information is complete. My child has permission to engage in all camp activities except as noted. The Release Form is signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. I agree that all information provided is complete, correct and factual.

Please Sign and Date Below

Media Release Form/Photo Release:  By signing at the bottom of this form I hereby grant free permission for The Ohmapi Nature Project to use images of me and my child participating in their programs, classes or events for outreach purposes, including but not limited to electronic or print materials or media. [ ] No, I do not wish to grant a photo release.(Please consider granting this release to us if at all possible, as our ability to successfully share our programs with new participants and for marketing our programs.)

Sign and Date Below

RELEASE OF LIABILITY: In consideration of being allowed to use the facilities and participate in activities (collectively the “Activities”) provided by The Ohmapi Nature Project (the “Host”), the Participant, and the Participant’s parent(s) or legal guardian(s) if the Participant is a minor, do hereby agree, to the fullest extent permitted by law, as follows: 1) TO WAIVE ALL CLAIMS that they have or may have against the Host arising out of the Participant’s participation in the Activities or the use of any equipment provided by the Host (“Equipment”), including while receiving instruction and/or training; 2) TO ASSUME ALL RISKS of participating in the Activities and using the Equipment, even those caused by the negligent acts or conduct of the Host, its owners, affiliates, operators, employees, agents, and/or officers. The Participant and his/her parent(s) or legal guardian(s) understand that there are inherent risks of participating in the Activities and using the Equipment, which may be both foreseen and unforeseen and include serious physical injury and death; 3) TO RELEASE the Host, its owners, affiliates, operators, employees, agents, and officers from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of his/her participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. The Participant and his/her parent(s) or legal guardian(s) specifically understand that they are releasing any and all claims that arise or may arise from any negligent acts or conduct of the Host, its owners, affiliates, operators, employees, agents, and/or officers, to the fullest extent permitted by law. However, nothing in this Agreement shall be construed as a release for conduct that is found to constitute gross negligence or intentional conduct; and 4) TO INDEMNIFY the Host, its owners, affiliates, operators, employees, agents, and/or officers, from all liability for any loss, damage, injury, death, or expense that the Participant (or his/her next of kin) may suffer, arising out of participation in the Activities and/or use of the Equipment, including while receiving instruction and/or training. Personal Responsibility The Participant and his/her parent(s) or legal guardian(s) certify that Participant has no physical or mental condition that precludes him/her from participating in the Activities and that he/she is not participating against medical advice. The Participant and his/her parent(s) or legal guardian(s) understand that Participant’s participation in the Activities is voluntary and further understand that they have the opportunity to inspect the Host’s Equipment and facilities before any participation. The Participant and his/her parent(s) or legal guardian(s) understand that Participant is obligated to follow the rules of the Activities and that he/she can minimize his/her risk of injury by doing so and through the exercise of common sense and by being aware of his/her surroundings. If, while participating in the Activities, the Participant or his/her parent(s) or legal guardian(s) observe any unusual hazard or condition, which they believe jeopardizes Participant’s personal safety or that of others, Participant and/or his/her parent(s) or legal guardian(s) will remove Participant from participation in the Activities and immediately bring said hazard or condition to the attention of the Host. To the extent that any portion of this Agreement is deemed to be invalid under the law of the applicable jurisdiction, the remaining portions of the Agreement shall remain binding and available for use by the Host and its counsel in any proceeding. I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

Participants Name and Date

Parent/Guardian's Signature and Date

Summer Camp Registration

Thank you!