Camp Wildcraft Enrollment & Waivers for Daily Program, Aug.12-16 at The Sycamore School, Malibu
Please complete one form for each child. Daily prorated rate is $80 per child payable by cash or check at drop off.
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Name *
Age *
Grade in Fall 2019 *
Are you a returning camper? *
If you're new to Wildcraft, how did you hear about us?
Day(s) your child is attending *
Required
ANY ALLERGIES OR MEDICAL CONDITIONS OR DIETARY RESTRICTIONS? IF YES, PLEASE DESCRIBE:
Parent/Guardian name *
Parent/Guardian email *
Parent/Guardian cell *
Parent/Guardian home phone
Parent/Guardian home address *
Emergency contact name & phone #1 *
Emergency contact name & phone #2 *
Name (s) of authorized pick up besides parent(s)
LIABILITY WAIVER--TO PARTICIPATE IN CAMP WILDCRAFT YOU MUST AGREE TO THESE TERMS AND SIGN BELOW: Camp Wildcraft directors and staff make every effort to conduct safe programs, and to orient children to the unique natural environment of the site. As camp activities take place outdoors in nature, certain activities may involve risks that children do not routinely encounter at home. These may include, but are not limited to: hiking on uneven terrain, playing active outdoor games, encountering local wildlife, insects, poison oak and other natural hazards. I acknowledge that such risks exist, and I hereby agree on behalf of my child to assume such risks. I understand and acknowledge that participation in Camp Wildcraft, including all of its activities and the use of its facilities can result in injuries, harm or loss. I authorize the child named in this registration to participate in all Camp Wildcraft activities at King Gillette Ranch, The Sycamore School and at nearby sites where camp activities take place, and on camp field trips which may include bus transportation. On my own behalf and on behalf of my child named in this registration, I expressly and voluntarily assume the risks of participation in Camp Wildcraft and HEREBY WAIVE AND RELEASE ALL CLAIMS (whether on behalf of the child named in this registration or for my own benefit) against Camp Wildcraft, (INCLUDING THE STAFF, DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS), that may arise from injuries, harm or loss resulting from participation in Camp Wildcraft to the fullest extent allowed under California law. If any aspect of this waiver is deemed to be invalid, I acknowledge that the remainder of the agreement will continue to have full force and effect. I acknowledge that I am acting as an agent of the other parent/guardian with authority to enroll the child named in this registration at Camp Wildcraft, and that I accept this waiver on his/her behalf. I hereby warrant that I am the custodial parent or legal guard of the child named in this registration, and on my own and said child’s behalf, I agree to the terms and conditions of this waiver. *
Required
Name of parent signing *
PHOTO RELEASE---I give permission to Camp Wildcraft to use, without compensation, photographs or video which may include my child’s image for purposes of documenting or promoting Camp Wildcraft in printed materials or on the World Wide Web. Campers will not be identified by name. *
Required
Name of person signing:
MEDICAL RELEASE: As parent or guardian of registered camper I hereby authorize Camp Wildcraft (including its staff, employees and agents), to act according to their best judgment in any situation requiring medical attention for the child named in this registration, including routine healthcare, administering prescribed and over the counter first aid and medications as needed/described, and seeking emergency medical treatment for my child if warranted. I agree to the release of any records necessary for treatment, referral, billing or insurance purposes. I give permission to Camp Wildcraft staff to arrange necessary related transportation for my child if needed. In case of a medical emergency, every reasonable effort will be made to contact me. In the event that I cannot be reached, I hereby give my permission for the personnel selected by Camp Wildcraft to secure needed medical treatment including to hospitalize, order and medications and anesthesia, perform X-rays, special procedures, or surgery. I understand that it is my responsibility to provide medical insurance coverage for the child named in this registration while they are attending Camp Wildcraft and to provide accurate and complete medical information. I acknowledge that the costs of any medical treatment provided to the child named in this registration that are not covered by medical insurance will be my sole responsibility.
Name of person signing: *
Please note today's date *
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