Camp Belknap Participant/Visitor Registration
Thank you for your interest in visiting Camp Belknap.  We are excited to see you under the pines. If you have already called or emailed and confirmed a visit, please complete this registration and waiver form.  If you have not contacted us yet, please go to the the website for directions on visiting camp: https://campbelknap.org/visit/.    You can go to that same site after you have registered to access the health screening form, site rules and more.  Please call camp if you have any questions (603)569-3475.
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Email *
What is your Name? *
Age?
List all persons in your party that will be visiting and ages of the participants
Record the Date that you are planning  to visit Belknap (please make sure you have confirmed with office staff prior to completing this form). *
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Record the Time of day that you plan to Arrive on site (9:30am- 4:00pm Only.  Please plan to depart camp by 4:30pm unless attending event that has been approved for later times.) *
What is the phone number  camp can call if a visit needs to be canceled or you need to be contacted the day of your visit? *
What is your connection to Camp Belknap (alumni, prospective camper, neighbor, etc)?
Do you have a planned meeting/visit with one of our staff and if yes, with who?
*PARTICIPANT WAIVER* I hereby wish to volunteer and/or visit the premises of YMCA Camp Belknap (“Camp Belknap” or “Camp”) (the “Event”). I confirm that I read and understand the camp policies and information provided for this Event.I agree to participate in the activities offered at the Event. I acknowledge and accept that even after reasonable precautions have been taken, these activities have inherent risks including COVID-19 Risks (as defined below) (collectively, “Risks”). I further acknowledge that some of these Risks cannot be eliminated without destroying the unique character of these activities and I hereby assume all risks and hazards incident to my participation at the Event. I hereby release, absolve, indemnify, and do not hold responsible Camp Belknap, its participants, administrators, board of trustees, directors, volunteers or any staff appointed by Camp Belknap, for any Risks, legal claim, hazards, damages, costs for any physical injury or accidents to me or damage sustained to my personal property that may occur during my participation in the Event.I understand that first aid and medical care are my responsibility and that the health care center is not open during the Event. I authorize the Camp directors or their delegate to act for me in their best judgment in any emergency.I understand that there is a current pandemic throughout the United States, and the world based upon a contagious virus referred to as COVID-19.  I understand that while Camp is taking all reasonable precautions to prevent the spread of COVID-19 as recommended by the United States Centers for Disease Control and Prevention and other governmental authorities, there is a still a risk that, by entering Camp’s premises and interacting with Camp’s employees, representatives and agents, I am at risk for contracting COVID-19, which can lead to severe illness, personal injury, permanent disability, and death.  Participating in the Event or accessing Camp’s facilities could increase the risk of contracting COVID-19. Camp in no way warrants, represents or covenants that COVID-19 infection will not occur through participation in the Event or accessing Camp’s facilities I agree to observe and obey all written rules, instructions, warnings, industry standards, safety requirements or procedures and further agree to follow any oral instructions given by Camp or the employees, representatives, and/or agents of Camp and other related authorities, including but not limited to the COVID-19 Protocol attached as Exhibit A.  I take full responsibility for knowing and acting within my abilities and limitations and adjusting or ceasing my participation as needed to ensure my own safety and the safety of others.  As used herein, “COVID-19 Risks” means any and all risks resulting from, or related to my access to Camp’s premises and my interaction with Camp’s employees, representatives and agents, including, without imitation: (a) those arising from or related to, in whole or part, any negligence, action(s), inaction(s), or omission(s) of Camp, including without limitation those arising from or related to the maintenance of any premises; (b) those arising from or related to, in whole or part, my negligence, action(s), inaction(s), omission(s), or intentional or wrongful acts; (c) those arising from or related to, in whole or part, my harm, bodily injury, personal injury, illness, death, property damage and/or property theft; (d) those arising from or related to actions of any kind caused by my negligence, action(s), inaction(s), or intentional or wrongful acts, or which may hereafter occur through no fault, wrongdoing, or negligence of Camp; and (e) those arising from or related to any illness, injuries, loss, expense, or damage of any kind to any person or property arising in whole or in part, directly or indirectly, from my own negligence, action(s), inaction(s), omission(s), intentional acts, or wrongful acts.I grant permission to Camp Belknap to use for any lawful purpose my likeness, image, voice, written materials, spoken words, artworks, and/or appearance as such may be embodied in any pictures, drawings, renderings, photographs, video recordings, audiotapes, digital images or the like (“materials”). I hereby authorize Camp Belknap to copy, edit, publish, display, distribute, and/or disseminate the materials. I agree that Camp Belknap has complete ownership of and may use the materials in any manner for any purpose in any medium, including, but not limited to, social media sites. I also agree that Camp Belknap has permission to release such materials to the news media. I acknowledge that I will not receive any compensation or remuneration for the use of such materials.Camp Belknap reserves the right to decline to accept an application. In addition, I understand that the Camp directors reserve the right to dismiss me for undesirable behavior or for other cause determined by the Camp. Camp Belknap also reserves the right to cancel the reservation and Event should circumstances make Camp operation impossible or unwise.I HAVE READ AND UNDERSTOOD THIS WAIVER AND RELEASE OF LIABILITY. I CERTIFY THAT I AM PHYSICALLY AND MENTALLY FIT TO TAKE PART IN ALL PARTICIPANT ACTIVITIES, UNDERSTAND THE NATURE OF THE RISKS THAT MAY ARISE FROM SUCH ACTIVITIES AND VOLUNTARILY ASSUMES ALL SUCH RISKS. I ACKNOWLEDGE THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE CAMP BELKNAP. I acknowledge and agree that all representations, consents, agreements, grants, waivers, authorizations, indemnifications and releases herein shall be regarded as made by me on behalf of my child and shall be binding on me and my child.  Furthermore, in consideration of releases possibly including me and/or my child in the Event, I hereby agree to be bound by and to perform all of the terms and conditions of the foregoing Release (including, without limitation, the provisions regarding release of all claims), as such terms and conditions may relate to my participation and/or the participation of my child in the program, if any. *
*SITE SAFETY RULES* General RulesAll participants must attend safety orientation upon arrival at camp. Alcohol, tobacco, illegal substances, fireworks, guns, rifles, knives, hatchets and pets/animals are prohibited for all participants. Children must be under the Visitor’s adult supervision at all times.  All swimming is swim at your own risk.  There is no lifeguard.  No one person may swim alone, you always must have at least one buddy.  Swimming areas are Main Dock, Cadet Beach and Outpost Beach.  Inform the Site Manager and seek permission before swimming.  Diving is only permitted in Main Dock Deep.Shoes must be worn at all times.Fires are not allowed without permission of the Site Manager. Only restrooms and potable water are available.  No food is available.  Water will be only available via spicket or sink as all water fountains are off.  All food trash must be packed out by participants.  Trash bags are available outside the facilities building.All Visitors must wear a mask upon arrival until allowed by the Site Manager to remove their mask.Required Hygiene practices for Day Use: a. Wash hands all persons must wash hands upon arriving at Camp Belknap at the hand washing stations. While on site we should practice good hand hygiene at all times. Wash your hands frequently, using soap and water for at least 20 seconds. We recommend washing hands, at minimum every hour or at any of the following times:i. Upon arrival at site prior to doing anythingii. After blowing one’s noseiii. Coughing or sneezingiv. Before, during, and after preparing/eating foodv. After using the toiletvi. After touching garbagevii. After removing gloves viii. After completing any cleaning projectsix. Before and after the work shiftsx. Before and after work breaksxi. After touching objects that have been handled by othersHandwashing is available at the following locations around camp:i. Outside the Facilities Buildingii. Outside Clark Lodgeiii. Timi-Hisiv. Junior Division Scollege b. Use hand sanitizer when soap and water is not availableHand Sanitizer will be available at the following locations around camp:i. Conlon Lodgeii. Hall Lodgeiii. Dining Hall Exteriorc. Avoid touching the face, eyes or mouth d. Practice good respiratory etiquette. This includes coughing and sneezing into a tissue or your elbow rather than into your hands. e. Wear a cloth face covering: Everyone is required to wear a cloth face covering to help protect against the spread of the virus in the following situations:i. When persons are within 6 feet of each other, either inside or outside (examples:  taking temperature, moving equipment that is smaller than 6 feet but requires two persons)ii. When inside any permitted building (bathroom or Conlon). iii. When requested to put on a mask by another visitor or staff person.iv. You are not required to wear a mask when you are outside and keeping to 6 or more feet from any person’s not in your visitor party.f. Practice social distancing: To the greatest extent possible, all employees should maintain safe social distancing, which means keeping a distance of at least 6 or more feet between one another at all times. g. Everyone should avoid sharing clothing, personal care products, water bottles and other belongings.h. Potable Water – is available only outside the Timi-His using the newly installed touchless water bottle fill station.  If visitor forgets a water bottle we will have disposable cups for use.   7. Clean places after use At the end of each use everything must be cleaned through the use of soap and water, wet wipes and/or sanitation spray as further outlined below:Program Activities:The following outlines permitted activities and the required cleaning after use. NOTE - Belknap prohibits playing with another guest that is not in your party/household using the same equipment/ball. Frisbee Golf – maps and frisbees provided• Guests may use Belknap frisbees, maps and play Frisbee golf.• Frisbees for Frisbee Golf must be disinfected with spray bottle by participants and placed in “USED” bin for end-of-day disinfecting by site manager.• Frisbee golf maps should be thrown out.Canoeing – canoes, paddles and lifejackets provided• Guests may use canoes with the permission of the Site Manager.  • Anyone in a canoe must wear PFDs at all times in boats.   • Keep boats in bay, in sight of Main Dock• At the end of use the canoes, paddles and jackets, they will be sprayed down via disinfectant pump bottle and left to dry by the guest.Junior Tennis – Bring your own racket and balls Junior Hoops – Bring your own basketball.   Messer Field – Bring your own equipment.  Main Dock – Swim at your own risk per rules outlined• At the end of use the tower and railings should be wiped down with a sanitary spray let to sit and wiped down by the guests. Ping Pong in Conlon – Ping pong may be played with people that are in your guest household/group.   • At the end of ping pong put the used balls and rackets into the sanitation bucket.Go for a Walk -  Enjoy!  But do not enter any lodges, scolleges or cabins.  If you desire to look in a cabin for a name, please bring a wipe and wipe the handle down after use.Volunteer Activities:The Site Manager and Facilities Director will coordinate on site volunteer activities.  Participants may only conduct activities approved by the Site Manager and Facilities Director. Guests will use equipment at their own risk.  Hand Tools and any Safety Equipment -Hand tools may be handed out each day based on the volunteer requirements.  At the end of the day hand tools will be lined up on the white fence and sprayed down with the sanitation spray and tagged out with a sign stating time of cleaning.  Safety equipment will be cleaned using gloves and sanitation procedures after use.Building Use:The only buildings permitted to go into are Conlon Lodge, Timi-Hi/Hers, and Junior Division Scollege.  Please keep all doors and windows open.  The pavilion may be used as well.  All social distancing rules including masks apply in all buildings.  Wipes should be used after use to wipe down any surfaces touched by participants.   *
Record Name here to confirm receipt, review and agreement of the waiver and site safety rules for all persons in the  party.  
A copy of your responses will be emailed to the address you provided.
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